We conducted a national survey where all relevant treatment services and psychotherapists with publicly funded individual practices in Norway received a web-based questionnaire. The leaders at the respective clinics and at the individual practices filled out the questionnaire. The response rate among the relevant treatment services was 59.5 %, and among the individual practices, the response rate was 12.1 %. Among those who responded, 147 treatment services specified that they provided treatment for children and adolescents exposed to violence and sexual abuse, 86 services reported that they offered treatment for children and adolescents who use violence, and 71 services reported treating children with problematic or harmful sexual behavior. The Child and Adolescent Outpatient Clinics (BUP) constitutes a significant amount of the total treatment services offered, but the Family Counselling Services, some Child Protective Service Institutions and treatment models implemented by The Norwegian Center for Child Behavioral Development (MST and FFT) were also represented. All geographical regions of Norway reported having treatment for the target groups. The main tendency, however, was that most participating services offered a generalized treatment service, i.e. that they mostly provided treatment to other client groups than to children affected by violence and sexual abuse. Furthermore, the vast majority of the treatment services reported that they only treated between 1 and 10 cases affected by violence and sexual abuse in 2014.
The results reveal that treatment expertise does exist for providing treatment to all three target groups. Most expertise is found, however, in treating children exposed to violence and abuse. The survey also showed that competence and expertise is most wanting for clinics providing treatment to problematic or harmful sexual behavior. Many clinics felt that they were unable to offer optimal treatment to the affected groups, and were particularly unsatisfied with the treatment they provide to children exposed to violence and sexual abuse. In order to improve the service for this vulnerable group they requested an increased capacity and more resources as well as improved cooperation between the treatment services.
Overall, the treatment services reported having good screening procedures in identifying clients’ background information, life situation and general mental health problems. Around half of the treatment services report that they systematically screen all clients for experiences with violence and abuse experiences. Fewer facilities, however, screen for violent acts and problematic and harmful sexual behavior.
The different services provide a wide range of treatment methods and treatment approaches, from specialized and well-defined methods, to more general treatment approaches, such as cognitive behavioral therapy and psychodynamic therapy. Many of the stated treatment methods are evidence-based, such as the trauma specific methods TF-CBT and EMDR. It was first and foremost the Child and Adolescent Child Guidance Clinics (BUP) who provided evidence based treatments for children exposed to trauma, while for children using violence, the evidence based methods MST og FFT were first and foremost provided by the Norwegian Center for Child Behavioral Development (Atferdssenteret). Generally, the treatment services were providing individual treatment above group and family therapy, and this trend was visible in the treatment of both exposed children and the children with problematic and harmful violent and sexual behavior.
An important result emerging from this survey was that almost one third of the services reported that they did not have any routines for collaboration and coordinating tasks between services in relation to the treatment of the children affected by violence and sexual abuse. At the same time, the services that did have routines for providing collaboration and coordination were satisfied with these routines, and overall they experienced the cooperation with other services as positive and satisfactory.
In short, the results show that all geographical regions in Norway reported having treatment for the target groups. However, few specialized treatment services were identified. The competence, treatment quality and treatment content varied among the different treatment institutions and target groups. One third reported that they did not have established routines for cooperation in cases where children and adolescents were subjected to violence and sexual abuse and where young people where violent or had harmful sexual behavior.