Co-creating a service with and for adult survivors of child sexual abuse 

In this post Debbie Allnock reports on learning from a recent evaluation of a Victim Support project working with adult survivors and the value of co-creating services with service users.

Few people reading or watching the news will have failed to miss the unprecedented attention to child sexual abuse / exploitation (CSA/E) in the media and the political arena.  More adults than ever before are reporting childhood sexual abuse to the Police or other agencies.  For instance, between October 2012 and March 2015, reported rapes to the Police increased dramatically by 87% (This was reported by the Rape Monitoring Group for 2014/15).  This phenomenon has been coined ‘the Yewtree Effect’ to highlight the social impact of Jimmy Savile’s widespread abuse reported by hundreds of people, as well as revelations of child sexual exploitation in a number of  British cities.

While this clear attention to sexual abuse is great progress in the journey to acceptance of a long-hidden social problem – and has opened a door for people to finally seek justice after many years of silence – it is also imperative that supportive services are equipped to respond sensitively to people reporting this crime.  Children, adolescents and adults have told researchers about poor experiences of service providers throughout their lives when they have reported – or attempted to report – their abuse in the past.  While it is easy to think that such poor experiences are in the past, recent research, inspections and news tell us that unfortunately those affected by CSA still face challenges with services and professionals that are meant to help.  Poor experiences of help-seeking can pose serious consequences for those affected by CSA in terms of their propensity to use and report to services in future, general help-seeking and ultimately on the process of over-coming their abuse.

Victim Support:  The Adult Survivor of Child Sexual Abuse (ASCSA)

Victim Support is national charity that helps anyone affected by crime. In this regard, it is a generalist crime service that does not specialise in any particular social issue(s).  However, in light of the increased reporting of what is sometimes termed ‘historical’ or ‘non-recent’ abuse, Victim Support recognised a concomitant increase in referrals to their own service and, alongside that, a need to strengthen their own response to adult survivors engaging with their service.  With funding from the Independent Inquiry into Child Sexual Abuse, and in partnership with the National Association of People Abused in Childhood (NAPAC), Victim Support launched the ‘Adult Survivor of Child Sexual Abuse’ project as a platform to strengthen its response in this area.  The project had a number of elements to it, including:

  • A review of the literature which identified good practice in supporting adult survivors of child sexual abuse and which was used to help ASCSA project facilitators shape their work with survivors. The review can be accessed here: Responding sensitively to survivors of child sexual abuse.
  • Co-creation of the service through engagement of a small group of adult survivors of child sexual abuse (referred to as ‘consultants’) to work in partnership with the project facilitators to design the new service. The International Centre evaluated the experiences of the consultants and the project facilitators, with findings accessible here Victim Support’s Adult Survivors of Child Sexual Abuse Project: An Evaluation of a Co-Created Service Delivery Model
  • And finally, practice guidance written by an experienced consultant entitled Hold onto your truth: Improving our response to adult survivors of child sexual abuse. This will be cascaded throughout Victim Support locales with the aim of embedding practice and improving adult survivors’ experiences of engaging with Victim Support.  The guidance will be available for purchase on the Victim Support website.

What did co-creation ‘look like’? 

At its simplest, ‘co-creation’ involves people who use services working with professionals to design, create and/or implement services.  Co-creation comes in all different shapes and sizes, however (check out this freely accessible review of co-creation and co-production!).  In the case of the ASCSA project, the model of co-creation I observed reflected the service user as co-designer.  In other words, while the initiative (the ASCSA project) sat within Victim Support, the service users (the consultants) helped to shape the service, alongside Victim Support professionals.  It is important to grasp here that the outcome is one that goes beyond the views of any one person – either the consultant or the professional.

In practice, co-creation in relation to the ASCSA project could be observed through the dialogic interactions between the project facilitators (and other Victim Support staff and volunteers, where they were involved) and the consultants, as well as in the final product (the practice guidance).  There were a number of activities that provided the ‘vehicle’ through which these interactions took place.  For example, early sessions with consultants focused on prior experiences of services.  Project facilitators also shared examples of tools and assessment forms with consultants to discuss the pros and cons of using them.  However, it was not the activities themselves that exemplified the co-creation, but the dialogic ‘outcomes’ that occurred in the process of discussion.  The project facilitators did not simply apply an ‘information collecting’ approach – where facilitator asks questions and consultant answers them (much like a doctor-patient relationship).  Instead, they had to engage in a conversation, taking a partnership approach where there was a good degree of give and take.  One project facilitator eloquently reflected on the personal and professional challenges of shifting practice to a partnership approach but ultimately found this a more satisfying way of engaging and developing the service.   An ‘information collecting’ approach would have been observed in transcripts through questions posed (by practitioners) and questions answered (by consultants). However, although we observed some questions posed (by practitioners), we also observed an exchange, whereby project facilitators engaged in a dialogue, often summarising back to the consultant what they had heard and whether their interpretation was correct.  This frequently led to further discussion and clarification until a final decision or agreement could be made by both parties about the issue under discussion.

The ultimate product of the co-creation process is the Hold onto your truth guidance report.  This report clearly reflects the outcomes of the discussions held between the project facilitators and consultants.  In particular, the report draws heavily on quotations and exchanges between facilitators and consultants, providing a clear ‘record’ of the ways in which consultants influenced the service design.  The consultants were invited to review the guidance, and be involved with and attend the service launch, providing further opportunity to validate the outcomes of service design.

What can an evaluation of an adult service tell us about working with young people?

The International Centre is well known for its work with young people, particularly in relation to child sexual exploitation.  So what does this evaluation of an adult support project offer in the way of learning?  Although working with children and young people to co-create a service would inevitably involve special considerations around age and development, there is some transferrable learning from co-creation of an adult service.  This short blog only highlights one particular issue: that it is not the activities which make co-creation but the exchange between practitioner and service user.   There are other points of learning from this project that transcend age and development in the context of co-creation, and may be helpful for colleagues within the International Centre and beyond.  I will be presenting a poster of this work at the forthcoming Research Forum on July 15th, 2016, which will share the wider findings as well as reflection from one of the project facilitators and one of the consultants that readers might find of interest.