How to structure a Consultation – roles

What is the responsibility of the municipal Child Welfare Service?
The municipal Child Welfare Service is responsible for the care of children after they have moved into a foster home or institution. We are responsible for following up on the children’s development.

You are a psychologist. What do you work with in the municipal Child Welfare Service?
My task is to counsel employees who follow up on the children or foster parents, and I to some degree work directly with children and adolescents.

How many children are part of this system?
Trondheim Municipality has chosen to organize this work around children who have moved into a unit, of which there are around 400. We have also had many singular minors who are now growing up, the number being as high as 2-3000, but decreasing.

What kind of counselling do you provide foster parents with?
It can be how to relate to the kids, or how to deal with challenges with the biological family. There is a lot of variety in the problems faced by foster parents.

Being a foster parent must be pretty difficult?
Yes, it’s an underestimated job.

And there is a shortage of foster parents, correct?
Yes.

But how often does harmful sexual behaviour appear in your counselling sessions?
I have specialized within the field, so it’s only natural to get cases relating to it; I always have a few active ones. I don’t have the numbers, but our unit is overrepresented because of the connection to neglect and behavioural issues. Research shows that children exposed to neglect, violence and similar problems are more prone to display problematic sexual behaviour.

How do you proceed with a case?
We do some assessments to determine severity, whom the behaviour is inflicted upon, frequency, and then we create measures based on this. Teachers and foster parents also come with suggestions to these. There are foster parents whom I frequently counsel in the beginning, and then the intervals between our sessions increase. It’s through these sessions with their foster parents I follow up on children’s development.

Would you say it’s important to watch out for harmful sexual behaviour early?
Yes, absolutely. We see very young children with these problems, and know from media and research that there is no age limit when it comes to being sexually violated. We also notice that children displaying this behaviour have themselves often been violated.

In your experience, regarding the help we provide children who have been exposed to harmful sexual behaviour, is it effective?
Absolutely! The vast majority finds it effective, and I have multiple examples; for instance, a five-year-old boy who was always touching the breasts of his foster mother, asked intimate things, and overstepped the boundaries of everyone he met. Younger siblings and other children required a lot of attention because of things he would do. He is now eleven and doesn’t do any of it anymore. He is very attentive of his foster parents, and checks to see if “this and this is alright”. He is attached, has changed his behaviour, and is very interested in the subject – but so are many others. It’s in a natural and exploring way, asking “is this alright”. A lot of other children should be counselled on the subject too, in my opinion.

In your experience, are we more aware of harmful sexual behaviour than we used to be?
Yes, luckily. It’s an expression of behaviour the same way violence is, and we appropriately respond to violent children. We should react similarly when it comes to sexual violations.

Since we are more aware of the issue now, foster parents need to be more aware as well, which in turn requires more from counselling. How has your role in counselling those affected by harmful sexual behaviour changed?
I am more requested, and we work with all the new information coming from the field. We try and tackle this subject the same as we do other subjects.

What part of your job brings you joy?
Seeing the changes, that it helps, and people being happy with their achievements.

Do you provide counselling to schools and teachers?
Yes, we do.

How does this happen?
It can happen with a work team made for managing a student displaying this sort of behaviour, and news travel, making people request us more and more. We have been asked to, among other things, have sessions with school staff – both smaller and larger groups – and provide supervision over a period of time to make sure the set goals are achieved.

Do you have any advice for a teacher who finds themselves in a challenging situation with a child displaying harmful sexual behaviour, and who feel this matter is difficult to work through?
My advice is to utilize yourself. If you have doubts about whether something is okay or not, speak to a colleague, or the management, or Rebessa, and discuss your worries. This is usually enough to decide if we should take the issue further. Discussing sexuality and adjacent themes were not covered in any of our education, leading to it being somewhat unnatural and weird to do. I therefore try to advertise myself to educational institutions, and the situation seems to have gotten better in recent years. People react differently to these subjects, because you are reminded of your own sexuality, and there may be other gripes even if someone isn’t affected by the subject matter. This is something I found very interesting and thought a lot about when I first started working in the field. I had colleagues who refused to talk about the subject, and we have to respect that decision, but other people can get past it, find it alright, and get to the point where speaking about this is no more difficult than discussing a shortage of food for school lunches, or other issues we bring up with parents and pupils. We should attempt to remove the subject of sexuality from the pedestal it is currently placed on, and make it a natural part of life. It is also a part of mental health, meaning we must treat it professionally.

But the way different generations discuss sexuality has changed drastically, with Paradise Hotel, Snapchat and similar things, so the divide between those under twenty and their parents has increased, correct?
Those who are young now have a different view of sexuality than my generation has. It was more embarrassing and taboo for us, and our issue was being more open, maybe. Now, though, the problem looks to be accommodating and respecting others, and being aware of how you may violate someone with actions you yourself think are normal. There is a good TV-show called “Innafor” (meaning: acceptable) on air right now. I sat down to watch it yesterday, and I really appreciated how detailed they were and the subjects they brought up. People need to learn about consent and seeing others’ perspectives. I have worked with bullying a lot, and the same problem arises; someone thinks they’re being funny, but the recipient experiences it as bullying. This also applies to sexual assault, where someone watched a movie or a porn, and thought it was a representation of normal sexuality, while in reality this is absolutely not how you get positive sexual experiences.

But maybe the generations over twenty have something to learn from young people when it comes to speaking openly about sexuality?
Absolutely. But young people could also stand to learn from the older generations about bringing feelings into sexuality. The trouble comes when you violate feelings, as factoring them out doesn’t affect the technicality of what is happening. But then there are also those who enjoy a little romance or feelings.

Barnehuset is multidisciplinary, and where children and vulnerable adults come in for questioning. They are offered counselling and medical assistance from health care workers, doctors, nurses, and dentists. We provide both children and their parental guardians comprehensive treatment after hearings.

The hearings are used in court, does that mean they are police hearings?
Yes, they are called “closed hearings” and is a part of the legal procedure of a police investigation. They can be used as evidence in court if the case becomes a trial.

Has the methodology changed while you have been working there?
I have been working at Barnehuset since 2009, and yes, I have seen a great deal of change. There used to be judicial hearings, which were conducted by a judge, and with a defense attorney present. However, in 2015 this was changed to facilitated hearings; the judge and attorney were no longer present. Today these hearings are administrated and organized by the police.

But you are the professional who can speak to the children?
I sit in an observation room during hearings, where my job is to observe the child being questioned. I’m looking for what kind of help or needs the child will have or have use of after the fact, as well as assisting the interrogator with insight and questions. I contribute with my professional knowledge of children.

So your focus is on the child’s best interest?
Yes, from start to finish. Others are present, among them a guardian if the parents are suspected of having harmed the children in some way. There is also an attorney who represents the child during the investigation, potentially into a trial, and, of course, an investigator.

There are Barnehus all over the country. How many are there?
There are 11 Barnehus.

Could you take us through the process of what happens to a child who has been exposed to sexual activity?
The preparations begin ahead of the day the child is scheduled to arrive – we call it a Consultation. There we discuss everything with police, the Child Welfare Service, a guardian and the investigator. Firstly, on the day of the hearing, when is the child arriving? Are they accompanied by mum, dad, a teacher, etc.? Then we review the case; what are the circumstances of the report, what is specifically reported, and what has happened. The interrogator prepares for the day of hearing, where they then welcome the child, and show them and the accompanying adult to a waiting room. Next, the child is brought into the interrogation room along with the interrogator, where they are to go over the circumstances of the police report.

How long does a hearing typically last?
It’s hard to say. It can be anywhere from half an hour to an hour, or two to three hours. It depends on the case, the amount of material to review, and the age of the child. When children under the age of 5 come in for questioning we arrange what we call sequential hearings.

Which is?
A sequential hearing is a hearing divided into modules. It starts with getting to know the child and their ability to answer questions, as well as checking if they understand numbers, can tell the time and things like that. Then we slowly move onto the subject they are here to talk about; why they were reported.

Children are not always happy to talk about what’s happened, are they?
No, sometimes children find it very difficult to talk about the worst – or some of the worst – things they have experienced. They can be held back by loyalty to their parent or parents, maybe even their grandparents if these adults are suspected of doing something wrong. Maybe other circumstances around the child prove to be difficult to manage, like diagnoses, or language – an interpreter might make the hearing more difficult. There are multiple circumstances with the potential to make proceedings harder.

If the person suspected of having exposed a child to unwanted sexual behaviour turns out to also be a child, will this child also be called in to Barnehuset?
Generally, yes, but not always. Barnehuset wants children suspected of exhibiting unfortunate or harmful sexual activity to be interrogated at Barnehuset if they’re being interrogated for a case, but sometimes it happens at the local sheriff’s office. Sometimes there aren’t even any representatives from Barnehuset present.

Are children often accompanied by adults from school?
They can be, but it really depends on the individual case. When a child or adolescent is suspected of exhibiting unfortunate sexual behaviour, their parental guardians are often a natural choice.

What about the parental guardians of children who have experienced unwanted sexual behaviour; how do they react, in your experience?
It depends. Many of them are shocked by the revelation, absolutely, so we want to establish contact with them – not just because of their child, but to offer help and following-up, either through dialogue or supervision.

What makes you feel like your job is important?
I personally find it rewarding when we help a boy – most of the people who commit sexual offenses are boys – get onto “the right path”, and he doesn’t get into more trouble. When someone has done a bad thing, it is motivating to help them realize they can find a girlfriend their own age and prosper sexually despite it all.

Can you provide some examples of unwanted sexual behaviour you see at Barnehuset?
Yes, there can be a great difference in age and maturity – a thirteen-year-old boy exhibiting sexual activity towards a six-year-old girl, for example.

How do you follow up on children after?
We offer to speak with both the child and their guardians, but it really depends on the severity of the reported circumstances, and what the adolescent has done specifically. The reported circumstance might not be that severe, but would require some conversations, and then we talk about sexuality, bodily boundaries and rules, and what could be smart to do in the future. Then there are those children and adolescents who have committed pretty brutal sexual offences. We might spend more time on them by evaluating and assessing them, and offering treatment. Parental guardians are of course included in the conversation, and some children might have problems or diagnoses which require us to cooperate with BUP or other authorities.

You work in BUP; Division of Mental Health Care, Department of Children and Youth. How did you end up there?
It’s a special and kind of unconventional story. You see, I got my education in the army, and worked for them both in and out of the country for 8 years. But then I wanted an occupation where I worked with people more, while staying in Norway. I also wanted to be in civilian environments after serving in the army. This turned into a bachelor’s degree in social work, and I was off – after going to the University of Stavanger, where I gained insight into the Child Welfare Service, psychiatry and that side of things.

Do all children and young people with mental health issues come to BUP?
No, they don’t. Only the Child Welfare Service and general practitioners are capable of referring people to us, since there are a lot of steps to get into the specialist health care service.

Do you feel there is an increasing demand for your professional expertise among children and young people?
Yes. Referrals have increased ever since I started working in psychiatry in 2012, but I also think adolescents are better at notifying adults and asking for help in general. What was never spoken about before is now on the table, and adolescents may talk to their teacher or the school nurse, who takes it up with the appropriate authorities. I think this has always been a societal matter, but people are now better at seeking help and advice.

Do you often see harmful sexual behaviour in your line of work?
I personally do, because that’s my specialty within the field, and therefore a significant percentage of my work pertains to it. It is in no way the main cause of referrals to BUP, but we see it more and more often. I would say there is an increase in older adolescents being referred, maybe because these are subjects no one talked about, or you felt you would be “arrested” for talking about them, though I do think this has changed. Before, these issues would be “snuck into” the referral, like in addition to being referred for ADHD, or assessment of depression or something else, there would be mention of unfortunate events involving a sibling, an underage boy in the neighbourhood, etc. Now, though, it’s more direct; this has happened, and we want help with it.

It sounds like treatment is better when the problems are iterated clearly?
Absolutely. I have also helped treat adolescents struggling with school refusal, anxiety, depression and eating disorders for years, and through treatment discovered sexual abuse, incest and various other things. Then it turns out we have spent years not really tackling the root of the issue, and maybe even diagnosed the wrong child. Being open and clear about it from the beginning is very much advantageous.

But the taboo is not gone, is it, even though things have improved?
Not at all. I have noticed a generational thing, though – I’m pushing forty, and think of myself as a pretty liberal person who can comfortably talk about a lot of things, but the adolescents from the ages of fourteen to eighteen dare to straight up say “I’m gay” or “I’m lesbian”. We see they have the courage to openly talk about things the previous generation kept a little under lock and key.

It is easy to criticize the Snapchat-generation, with reality TV like Paradise Hotel sending all the wrong messages, but there is a kind of sexual revolution happening as well. Could there be a positive side to it with the way this generation dares to speak about issues that were kept quiet before?
Yes, I think there are both pros and cons to the programs you mention – Snapchat and all that – being so accessible and developed. The fact it makes us talk about these subjects is a pro, but a con might be children growing up thinking “this is how it is”. We adults have to step in when children find themselves thinking “I’ve been okay with this so far, but I’m having issues with it now”, by telling them that what they see on TV and in photos is not how it should be, necessarily.

What kind of help do you offer children and young people at BUP?
We offer many kinds of treatment. Our focus is not on the events described in the referral – because of the taboo and how difficult it is to speak about – but rather “why did you end up in this situation, why is it like this for you?” Suddenly we get a lot of different underlying causes, which is what we are interested in. In our experience the dialogue is easier when those we speak to are allowed to express their own reasons and perspective, and not just talk about the events in question.

Then if I am a teacher and suspect a pupil of displaying problematic sexual behaviour, I’m supposed to confide in the principal and general practitioner rather than BUP directly, as these are the only two with the authority to refer to you, correct?
We also get anonymous calls among the referrals, where someone asks for consultation. An example is someone calling because the parents of the child in question won’t agree to a referral. Parents, in our experience, find it difficult to have that phone call, and don’t want to acknowledge the conduct of their child. I think this might relate to the old feeling of shame where your child’s poor decisions reflect badly on you as parents, and imply they learned this conduct at home. But we don’t think this way anymore. To sum it up, there are people who call us to discuss cases anonymously, and get some extra help to handle a situation.

These subjects are a bit taboo in some teaching spaces, with few others willing to discuss and talk about a case. BUP is kind of like an undercover back door where one can be advised on what to do, isn’t it?
Yes. I have done a number of anonymous consultations for adults working in grade 8, all the way up to grade 13, where they just want to be heard and seen. When parents are on board, it usually works out, but when parents are willfully ignorant the educator is stuck managing the problem alone, which is when it becomes difficult. They have to try and help the child or adolescent to find the motivation to seek help themselves.

We touched on it before, your impression of adolescents having an easier time speaking openly about things deemed taboo by the previous generation, but what do you do if they do not want to talk about it?
Most people want to talk about it, in my experience, but I do meet quite a few adolescents who have been reported to the police, and therefore are being followed up on by the Mediation Service as part of a follow-up. Their attitude is usually: “I can show up, but I won’t say anything”. Since we have to be there for 10 hours anyway, I figure we’ll just find a place to begin. And now we circle back around to the question “why did this happen to you, why are you in this situation?”, which they often have a few thoughts about, and slowly but surely the ball starts rolling. The first few sessions we don’t focus on how their actions are punishable by law – we try to get rid of the shame to allow dialogue. It’s after that we need to be honest and tell them if they don’t stop what they’re doing, they might be convicted in court, and there are pretty heavy sentences given to people over 18 who have done the exact same things.

You also help the parents, and they are a part of treatment. Can you tell us how this works?
We always wish for the parents to be involved when the child is under 16, but when they are over 16 the duty of confidentiality kicks in and other rules apply. I do feel we get more out of it when parents are involved, but I have encountered parents who can get mad with me and how I treat their child. They might be of the opinion I’m making the issue worse by talking about it, and giving space to talk about it makes the stigma worse for the family. Some parents have wanted to remove their child from the clinic and get private treatment, to name an example. Involving the parents is a lot of work, but we can insert another practitioner to help, meaning the parents can be in contact with my colleague as well. This works better for me, too, as I can focus more on the child, but we do after a while need to sit down together and attempt to cooperate on the issues at hand.

What about your work brings you joy?
Meeting the people who have fallen so far to the wayside they have been bullied or penalized for their actions, and then working with them to figure out how to not get into those same situations. They can go from being thrown out of school to being allowed back in a few years later, without these issues hanging over their heads.

What is the best thing about helping children and young people who display harmful sexual behaviour?
It’s what I just mentioned – helping them find a better way. I also think the responsibility of resolving these problems lies with all of society. Research shows that there is very little to be done if treatment is late, but here we have a golden opportunity to come in early and incite a change of behaviour, preventing children from both being exposed to and display such behaviour. I find this a very nice contribution to the effort.

What do you do if a child or adolescent displays harmful sexual behaviour?
It depends on which region of the country we’re talking about, and if the child is placed with or already in Bufetat. In Mid-Norway, if the child is associated with Bufetat, we organize a consultation with Rebessa, where the first order of business is to make an overview of the sexual behaviour in question.

Then, based on your findings, you help homes or foster parents to implement various measures?
Sometimes the behaviour is not especially concerning, but other times, yes, we implement some of the heavier measures, and make safety plans with institutions or foster homes. A few of us employees from the regional office in Mid-Norway help foster homes or institutions with safety plans. A safety plan is a plan detailing how to avoid new violations.

Does this mean you intentionally set the bar low when identifying sexual behaviour so you can earlier intervene?
We try to. I have worked in child welfare with these measures over a substantial period of time, and we maybe used to minimize the issues and call it sexual playing and exploration, not taking it as seriously as we do today. We have the Traffic Light now, a tool measuring severity on an individual basis, and there are assessment tools helping us to dig deeper. These make it possible for us to draw up detailed plans to prevent a child or adolescent from committing more sexual violations against others – if that is the problem we are faced with.

How do you identify what is normal sexual behaviour when all children and young people are unique sexual beings?
The children who come to the Child Welfare Service – maybe in an institution if that is the best option – have experienced things many adults have not – and thank the lord for that. These experiences may result in difficulties with emotional regulation, and some of the adolescents masturbate to calm down, which is inside the realm of normalcy. Maybe the adolescent needs some guidance in how to masturbate, and this may be part of treatment, but there is a chance of it being blown out of proportion, yes, which is what we try to assist with.

Is sexual behaviour – and unwanted sexual behaviour, to some degree – normal with children and young people who end up in institutions or foster homes?
No, there is no basis for saying that. A good colleague of mine says that when someone has large issues in many areas it would be weird if sexuality was not also a part of that. All adolescents are in a phase where they explore and test things out, and those entering child welfare institutions should also have every opportunity to do so. We want to emphasize healthy behaviour as well.

Do you provide supervision to parents or foster parents?
For the first year after a child moves into a foster home, the foster parents are supervised by us in state-run child welfare. The municipal Child Welfare Service takes over after that. From January 1 2022 the municipal services will handle all supervision. But since I have the chance I want to mention something else: there are municipal foster homes, state-run foster homes and treatment foster homes, and we sincerely hope the best offer for some of these children with harmful sexual behaviour can be the treatment foster homes. Creating a safe framework is always difficult, and having to be on the lookout 24/7 is very challenging for both the adolescent and the staff. But a treatment foster home is tightly supervised by psychologists, family therapists, other counsellors and teachers, as well as free of other children. I have high hopes, especially since institutions have several adolescents living together, which is always a challenge; no matter the form or severity of the problems of the individuals, making sure 4-5 adolescents develop properly while living together is very difficult.

We talked some about this in other interviews, where if teachers feel they aren’t taken seriously by anyone about their concerns regarding a pupil with problematic sexual behaviour, they can call authorities to speak with them anonymously. Are you one of those, do you get many “under the table”-phone calls?
We do get a few, I imagine, but school is challenging for children in child welfare. Finishing and doing well in school means a guaranteed future. We therefor heavily invest in schools, and every child welfare institution has their own contact within the staff. In other words, there is close cooperation between schools and child welfare, and an institution might even be in contact with several schools – both for the upper and lower secondary levels, sometimes even down in primary. The school contact is the center of this type of operation, but the adolescents living in institutions all have their own main contact who help them with homework and those kinds of things. In regard to treatment foster homes, I am sure we will establish great contact with schools. Foster homes are, by definition, a normal home welcoming a child or adolescent; they are supposed to cooperate. Sometimes it’s challenging, other times it works out fine, and that’s just how it is.

You have worked in this field for a while – what are your reasons for staying?
All this about harmful sexual behaviour just came about, to be honest. I have worked with adolescents facing challenges regarding sexuality, but only 4-5 years with a clearly defined subject. A good reason for going all in when it comes to children and adolescents with harmful sexual behaviour is the research showing how 85% of them will not repeat the behaviour if given an adequate reaction, good counselling and training in what is okay and what’s not. Though I am now trying to be a bureaucrat, I have worked directly with a lot of children and adolescents, which is rewarding and sometimes extremely challenging. The teachers watching this will understand how difficult it is and how sometimes it’s hard to figure out why children react the way they do – have you done something to set them off? – but this also helps to develop and widen the professional field.

Do you have any advice for teachers who find this hard to do?
Yes. Most of the children I’ve known really appreciate if you are able to look them in the eye and tell them in simple terms what you want them to do and not do. Also make sure the child knows you want the best for them; the minute a child or an adolescent starts to doubt your intentions, the foundation is ruined. So you need to genuinely want to help them, and when they discover this they often begin to let their guard down.