It is a major component of the prevention of child sexual abuse. It is a key component of the therapy for children who have suffered sexual abuse. And it can be painful for parents and children who are impacted by this form of child abuse.

  It is, simply, talking about it.

  One who does talk about child sexual abuse, and has made it her life work to make sense of what she calls this "insidious epidemic," is Esther Deblinger, a Ph.D. in clinical psychology and co-founder of the CARES Institute at the University of Medicine and Dentistry of New Jersey- School of Osteopathic Medicine. The CARES Institute is the southern regions only comprehensive diagnostic and treatment facility for children suspected of experiencing abuse and neglect.

  April is Child Abuse Prevention Month, a time when Deblinger and pediatrician Martin A. Finkel, DO, her CARES co-founder, try to turn up the wattage on child abuse research and education, although their mission demands a constant spotlight on the problem.
  "You have to," says Deblinger, who joined up with Finkel 18 years ago. "child sexual abuse is a crime of secrecy and silence. Ninety percent of sex offenders know their victims, often have a relationship with the victims or their families. For the sexual abuse to go on it requires secrecy.  By keeping the children silent, one person can abuse 100 children or more over a lifetime."

 Finkel started CARES (Child Abuse Research Education and Service) because he was frustrated treating children of child abuse solely as a pediatrician and envisioned a spectrum of professionals and care that could address both the medical and mental health needs of sexually abused children in a coordinated manner.

  "There was only so much he could do," said Deblinger. "The ultimate impact is on the child's psychological well being. So he asked me to join him, and together we work with parents and children who come to us here, while we also train medical and mental health professionals at other institutions to provide optimal care."

  Deblinger has conducted research to identify, design and evaluate effective therapies for children who have suffered sexual abuse. The research, which began with a $25,000 grant from the Foundation of UMDNJ, has earned $5.8 million in federal grants during the Finkel-Deblinger partnership at CARES.

  Their research and hands-on experiences have shown why shining a light on child sexual abuse - teaching, communicating, explaining - is so vital. And tricky.

  "For parents, it comes down to reducing the risk that your child will be abused," said Deblinger. "But there is no 100 percent prevention. In fact, we want to be careful not to overprotect in the name of prevention, which limits a child's ability to grow, learn, have fun."

  Deblinger lists these approaches for open communication:
  --Communicate about child sexual abuse as a safety issue. "We teach children about
bike safety, car safety, fire safety, but not personal body safety," she
says.
  --Communicate about child sexual abuse as an anatomy issue. "We need to feel
comfortable explaining to children about private parts of the body," she
says. "A child will tell Mommy if their ear hurts, but not if something has
affected a private part. Sometimes this is simply because young children don’t have the comfort or even the words to explain what happened to them.  We should teach children the “doctors” names for the private parts – vagina, breasts and penis, not nicknames, which may inadvertently convey our own discomfort.”
  --Educate children about child sexual abuse, formally, in schools. Deblinger notes the New Jersey legislature passed a law in 1992 requiring all schools todevelop and implement a policy to end bullying, but the legislation regarding child abuse that passed in 2003, only says schools 'may' include instruction about it in their curriculum.

  "The most important part of the communication between parent and child is to help the child understand the importance of telling about abuse if it occurs," says Deblinger.  “We must help children to understand what child sexual abuse is and that offenders are not typically strangers, but more often individuals they know well such as family friends, relatives, and/or older peers.  It is also critical to help children understand that offenders use threats and/or even the strength of their relationship to keep children silent.  Thus, we must educate children to know that they may feel compelled to remain silent and they may even be threatened, but they should recognize these threats as tricks offenders play and tell someone they trust anyway!"

  Deblinger has seen progress in the recognition of child sexual abuse, noting that 20 years ago some statistics showed one in four girls and one in six boys could be victims by their 18th birthday, but recent research suggests that that number may be declining.  Still, the Internet explosion may have created a new type of abuser.  The internet may provide predators with another means to contact and lure youngsters into inappropriate sexual interactions.

  “The Internet also may provide teenagers with easy access to pornography,” says Finkel, “leading some to engage younger children in age inappropriate sexual interactions.  In fact, 40 percent of the sexual abuse cases at CARES now involve teenage abusers.”

  Anyone is welcome to contact CARES for advice and help. Most of the children
and parents who come to the CARES Institute on the UMDNJ campus in Stratford
arrive via the Division of Youth and Family Services (DYFS), or county prosecutor’s offices.

  For the parents, the lessons are: how to respond, how to heal, how to foster the incredible resiliency of children, how to go forward, with open communication and optimism about the future.

  For the children, the therapy centers on the present. Says Deblinger, "The greatest focus is on the present because everyone involved has to be committed to healing and moving forward.  Although we talk about the past abuse, we discourage rumination about the past, or worry about how the past will impact.  Rather we help children acknowledge and openly communicate about their abusive experiences with their parents with a focus on recognizing their strengths as individuals and as a family. "

  Child sexual abuse, says Deblinger, knows no neighborhood boundaries, family makeup or socio-economic class.

  "Dr. Finkel and I and our colleagues here at CARES are pleased to speak about child abuse to community groups" she says. "Our mission is to break the silence and to ultimately reduce the incidence of victimization.  However, we must continue to devote much of our time to developing and providing services that will optimally assist children and families in the healing process.  A child who is brave enough to disclose abuse deserves no less.”