For reasons of confidentiality, some of the names in this article have been changed.
Michelle steeled herself as she prepared to enter the double doors of a building that looked like nothing more than just another private residence among all the other small apartment complexes on the street. At 15 years old, she was tired, afraid and determined not to talk. “I was done,” she recalls with an unmistakable resoluteness in her voice, even now, six years later. “There was no way I was going to open up. I had never fully talked about it with anyone. I wasn’t going to then, either.”
But as she walked into the lobby, she entered a warm and inviting environment, watched over by a gigantic plush pooch flopped in the corner. Arts and crafts lined the archway over the registration counter, built lower than normal to better accommodate a child’s-eye level. A playroom overflowed with books, games and a Noah’s ark of stuffed animals. A friendly volunteer invited Michelle to color, and, without pause, the teenager began drawing pictures.
This place wasn’t like her home, where Michelle slept in a closet without a blanket and had long felt unsafe. And it wasn’t like the police station to which she had been taken in the back of a patrol car and interviewed repeatedly by at least six different officers in between periods of being left alone for what seemed like endless stretches in a cold, stark interrogation room. Michelle was a victim in search of help. But to her, the officers in uniform wearing guns “were scary and mean-looking.” She thought she might be arrested. In fact, it wasn’t until years later that she realized she hadn’t actually been arrested.
Here, however, she was immersed in a completely different atmosphere, one where every detail was carefully chosen to make a child or teen comfortable and at ease. Michelle’s guard began to lower just enough to move forward. One step. And that first critical impression was enough for the staff of Stuart House to begin guiding her on the road to becoming a survivor.
Stuart House, a project of the rape treatment center at UCLA Medical Center, Santa Monica, is a pioneering multi-agency program that was designed to help sexually abused children obtain medical care, justice, therapy and long-term healing.
“When I first went to Stuart House, I was 100 percent sure it wouldn’t help me,” Michelle says. “I never had anyone I could count on. I thought to myself, ‘I can’t do this.’ But after a month, I thought, ‘I’m not alone anymore. Someone really cares about me.’”
Stuart House not only has helped child victims, it also has worked relentlessly to change the structure for addressing their needs. Staff have sought, since Stuart House was established in 1988, to improve the treatment of child victims and remedy problems in a child-protection system that often re-traumatized the very children it was trying to aid, in some cases leaving them vulnerable to subsequent abuse.
“The traditional child-protection system in place at that time was fragmented and ineffective,” says Gail Abarbanel, co-founder of Stuart House and executive director of the Rape Treatment Center. “It needed to be changed.”
In the mid-to-late 1980s, the issue of child sexual abuse was receiving increased national attention that emanated, in part, from news coverage of the McMartin Preschool trial in Los Angeles and a made-for-TV movie called Something About Amelia that starred Ted Danson as a father who molested his daughter. Reported cases of child sexual abuse mushroomed, and the number of children referred to the Rape Treatment Center increased significantly.
“The issue of sexual abuse of children started to emerge more prominently, but there were few resources and no expert care, and families couldn’t find out what was happening with their children’s cases,” says Abarbanel, who, at the time, was the only social worker assigned to Santa Monica Hospital’s Emergency Department. (Santa Monica Hospital became a part of UCLA Health in 1995.) “We kept hearing the same experiences from victims and their families: Children were being taken to different locations where they were interviewed over and over again, sometimes as many as a dozen times, and usually by individuals who were untrained in child development or in treating traumatized children. So we decided to remedy the situation by coming up with a model that would bring all of the involved agencies and professionals together under one roof.”
Abarbanel and co-founder Aileen Adams, who was legal counsel for the Rape Treatment Center, went to the hospital administration and top city and law-enforcement officials to unite them in this cause. “The results were outstanding,” Adams says. “The cultural shift that needed to take place required that everyone in the system had to view the system through the eyes of the child. Once they did that, they knew there had to be a change.”
A first-of-its-kind public/private partnership was created that included staff from the Rape Treatment Center, law-enforcement agencies including the Los Angeles Police Department and the Los Angeles County Sheriff’s Department, the Los Angeles County District Attorney’s Office and the Department of Children and Family Services (DCFS) — all working together as a multidisciplinary team in a single location. It was a revolutionary way of interacting with child victims of sexual abuse. The Stuart Foundation, founded by family members of the Carnation Company, provided funding to establish a facility near the hospital and a 10-year grant for operating support. “They gave us our roots and our wings. Their commitment freed us to focus on building the program without having to worry about fundraising for the entire operating budget in the beginning years,” Abarbanel says. In tribute to the seed funding, the program was named Stuart House, after the benefactors. Today, The Rape Foundation, an independent nonprofit organization, raises funds and provides financial support for the Rape Treatment Center and its programs, including Stuart House, in part by holding major fundraising events such as the annual John Varvatos Stuart House Benefit.
Since Stuart House’s opening almost three decades ago, more than 400 child-advocacy centers have been created nationwide. “It was a kind of clarion call to the country that when agencies seeing abused children work together, the results are much better — better for the victim and better for the professionals who work as a team,” says Adams, who later served in the Clinton-era U.S. Justice Department as director of the Office for Victims of Crime, which provided funding to support the growth of this model across the country. “There’s a much more holistic view of how to do this now.”
Still, Stuart House — equipped with its own emergency medical/forensic clinic that is open 24/7 and with police detectives, deputy district attorneys and social workers who are assigned to the program — remains the most comprehensive by incorporating services to meet all of a child’s needs. Today, Stuart House is an internationally recognized model program that effectively expedites criminal investigations and child-protection actions, while providing comprehensive, state-of-the-art medical care, forensic services and specialized therapy to child victims and their families. No one is turned away, and all services are free.
While it is widely believed that cases are underreported, it is estimated that one out of every four girls and one-in-six boys are sexually abused — and 90 percent know their abuser. The children affected represent every racial and ethnic demographic imaginable, in every community, living in poverty or luxury. Stuart House currently treats about 650 sexually abused children under the age of 18 per year; the youngest is a 3-month-old.
Among the children and adolescents who were brought to the Rape Treatment Center’s Verna Harrah Sexual Examination Clinic during one typical weekend were a 3-year-old girl, an 11-year-old girl, an 8-year-old boy, a 12-year-old boy, a 13-yearold girl and her 10-year-old sister and a 15-year-old girl. The reported assailants in these cases included parents, stepparents, classmates and teachers.
Having a state-of-the-art clinic on site that is dedicated exclusively to victims of assault eliminates the need for a child victim to be triaged in local hospital ERs, where they may have to endure long waiting periods that, in addition to being stressful in their own right, contribute to the erosion of DNA and other evidence.
“When a child is sexually abused, the child’s body is a crime scene,” says Beth Cranston, legal counsel for the Rape Treatment Center and Stuart House. “Time is not your friend.” Local ERs and first responders will, whenever possible, bring child victims to the UCLA clinic, which is equipped with high-tech equipment to perform evidentiary exams in a therapeutic fashion. In cases that cross state lines, the FBI also has used the facilities for interviews and medical care. A child is seen right away and never has to wait among other patients, and a therapist accompanies him or her through the entire process, from intake in a child-friendly room to the forensics examination to counseling. A police detective and DCFS worker are on hand to ensure that the child will be released to a safe environment. And the law-enforcement officers and social workers assigned to the child will remain on the case for the duration of any criminal or judicial proceedings.
Recognizing the need to provide treatment for even more children, The Rape Foundation launched an $18-million capital campaign to build a significantly larger three-story, 19,000-square-foot facility, adjacent to UCLA Medical Center, Santa Monica. The campaign is co-chaired by philanthropist Cheryl Saban, herself a survivor of rape when she was a teenager, and actress Viola Davis, whose sister, at age 8, was a victim of sexual assault.
“I was silent for years,” Saban said at the groundbreaking for the new building in May 2014. “I didn’t have the benefit of psychological help or the comprehensive support that Stuart House provides. ... The very least we can do as a society is provide a safe place where they can tell what happened to them, heal and begin to live again.”
UCLA provided the land for the new building, which is designed by architect Marc Appleton of Appleton Partners LLP and Andy Cohen, co-CEO of Gensler, a global architectural planning and consulting firm. When the building opens in Fall 2015, it will increase the capacity to add additional police, prosecutors, DCFS workers, advocates and therapists at Stuart House, thereby doubling the number of children who can receive comprehensive medical care, forensic-interview services and therapy services.
The new building also will house a training center for first responders such as police, prosecutors, school personnel, agencies that serve at-risk-populations and healthcare providers. First responders can have a significant impact on the outcomes in sexual abuse cases, “yet, despite their crucial roles, they often have minimal training in managing the medical, forensic and psychosocial aspects of these cases,” Abarbanel says. “The expertise and sensitivity required of them, and the challenges they face in these cases, are due, in part, to the diversity they confront in the circumstances of child sexual-abuse crimes, as well as the characteristics of individual victims.” The training will also cover advances in technology, such as medical imaging and DNA-evidence gathering, along with changing crime patterns, such as the increasing use of social media and digital technologies. “These changes pose new challenges and require first responders to have new skills,” Abarbanel says.
In addition, for the first time, Stuart House will have a dedicated play-therapy space to help younger children express their feelings and resolve sexual-abuse trauma in an age-appropriate way. And there will be a mock courtroom that includes an elevated judge’s bench and witness stand to help children become accustomed to the environment they will face if they must testify in a criminal case. There also will be offices to house staff who provide school-based prevention-education programs that reach 20,000 middle school and high school students each year. The prevention programs are designed to decrease the prevalence of sexual violence and abuse and encourage child victims to report these crimes. Because sexual abuse is a crime of secrecy and manipulation, supporting children in telling is a key component.
Michelle was 13 when she first tried to tell. After she revealed that her father was physically abusing her, DCFS placed her in a foster home. During mandated therapy sessions, Michelle said her father described what had happened as a misunderstanding: He had not meant to hurt his daughter. A month later, she was sent back to live with her parents.
That’s when she says things escalated. Michelle’s mother had become pregnant, so to protect her and her future sister, Michelle stepped in to shield them from the domestic violence that had been going on for years. The beatings, however, were not the worst of it. What Michelle had never told anyone, she says, including DCFS, was that her father had been raping her almost nightly for two years. And her mother, Michelle says, was in such a traumatic state from years of domestic violence that she did nothing to prevent the sexual abuse. After returning from foster care, Michelle’s father became even more controlling, she says, escorting her to school and even monitoring the frequency of her showers. He became jealous and enraged if he saw her talking to a boy at school. He forced her to act like his girlfriend in public, Michelle said, holding hands and kissing on the lips. If she refused, he hit her. Although school was Michelle’s safe place, she isolated herself, as a protective measure. At home, she withdrew into a make-believe world, pretending to be a heroine from the Twilight movies who was being rescued by Edward, the hero. The fantasy, she says, helped her survive her real-life horrors.
Then, one day, she says, her father hit her so hard across her face that the abuse was visible. Her mother tried to use concealer to hide it. But her cheekbone was noticeably swollen. At school, a teacher noticed and pulled her from class after lunch. At first, Michelle said she fell down some stairs. “I was afraid that if I got taken away again, it was going to get even worse,” she recalls. Her teacher brought in the school counselor. Together, they stayed with her from noon until 5 pm. By now, Michelle had started crying, harder and harder, she says, until finally she disclosed not only the physical abuse, but also, for the very first time, she told someone about the sexual abuse. The police were called, and Michelle never went home to her parents again.
Children aren't brought up in society to say bad things about adults, particularly those in positions of power like teachers, coaches, parents or caretakers, says social worker and Stuart House expert child-forensic interviewer Nicole Farrell. It’s completely contrary to what makes sense to them, so it’s essential to understand the nuances in children’s communication. There are significant developmental differences that a trained interviewer can draw out without putting words into a child’s mouth. “We are trained to create an environment that supports children emotionally through the pain with recalling and talking about the abuse — facing their darkest and innermost secrets,” Farrell says. “Often they have been living with abuse for years, and they are wondering whether to endure it or let it out, and what will be the consequences of letting it out.”
Children test the waters, Farrell says. They reveal the smallest detail possible and watch an adult’s reactions, gauging whether or not they are safe to disclose more. In some cases, Farrell says, a younger child may say something like, “I don’t like Uncle Joe,” and think that they are telling. An older child, on the other hand, is more likely to be riddled by shame or feel guilt, so they will tell what they believe to be the least embarrassing part, she says, revealing something like, “He comes into my room at night and looks at me.”
Stuart House has Spanish-speaking interviewers, and interviews in other languages are available if needed. Interviewers also work with disabled children. Sometimes a physically disabled child who may not be able to talk is the victim, but he or she can still communicate, and the interviewers know how to elicit the account. One boy with cerebral palsy, for example, had reported being sexually abused by a family member. The interviewer asked him questions in steps. When asked what the first thing was that happened, the boy locked eyes with the interviewer and made a motion with his fingers to indicate the locking of a door.
At Stuart House, the forensic interviews are conducted in a private room, while detectives, deputy district attorneys and others in an adjoining room observe from behind a one-way mirror. The interviews are recorded, with the child’s knowledge, and become part of the official record. With younger children, the recording may be played in court in lieu of the child’s testimony.
The interviews can provide key evidentiary details. For example, during one interview, a child described a vehicle where she said she was being sexually abused. “The minute we heard that, we picked up the phone (in the observation room) to obtain a warrant and went and seized it, impounding it as evidence,” says Detective Wilfredo Ortiz, from the LAPD’s Abused Child Unit, who is assigned full time to Stuart House. “And DCFS, being at Stuart House, was able to create an immediate action plan in terms of keeping the child safe. We work as a team, and sometimes we are the voices for those kids who can’t ask for help, and we try to help them,” he says.
Los Angeles Chief of Police Charlie Beck, who, during his career, has been involved in pursuing more than 1,000 sexual-assault cases involving both children and adults, is an ardent supporter of the program and recalls the days when he was a first responder. “Invariably, you show up on the scene in the worst moment of their lives, and the desperate hope coming out of the despair when they look at you is palpable,” he said during the Stuart House groundbreaking. “You come in as a knight in shining armor, so to speak, and you see that in their eyes. That’s the good part. The sad part is that you know that it’s not true. You know that the hope that you’re going to fix this somehow is false.”
Because of Stuart House, Chief Beck said, the LAPD is more successful at catching and prosecuting child abusers. “But no matter how successful we are at what we do, it doesn’t fix the tragedy,” he said. “It doesn’t restore the soul of the victim. That’s what Stuart House does.”
When Michelle returned to school two days after she was put in foster care for a second time, a school counselor referred her to Stuart House. “She told me I was in shock and that I couldn’t just cry and cry and cry,” Michelle says. “I needed more specific type of support. But I wasn’t convinced at first because I had this mentality that therapy was for rich people — that it’s what they did to not face their problems,” Michelle says. “But I thought I would go and get it off my chest and move on.”
That’s when she first crossed the threshold of Stuart House. After drawing in the waiting room, Michelle went to the interview room. By this point, she was tired of repeatedly telling her story, and she wasn’t convinced she needed to be there. But as the interviewer walked her through the room and reassured her that she was safe, Michelle felt relief. She left making an appointment to return for one-on-one therapy. During her first session, she noticed there were dolls and other toys in the room. The therapist asked her if she wanted to play with the dolls. “I told her no, I was too old to play with dolls,” Michelle remembers. The therapist slowly picked up a doll and said that it was OK, they could play together. Soon Michelle, too, began to play. “I began playing, thinking, ‘So, what’s my doll going to wear for an outing?’ Then, all of a sudden, it brought me back to the moment when I was 4 or 5 or 6 and loved playing dolls with my grandma. I mean, the therapist, she’s not my grandma, but that’s how my grandma made me feel — so safe.” That was the beginning, Michelle says, of when she fully disclosed to her therapist how she really felt. “It made me open up.”
As Michelle continued with her treatment, she says, she realized how much her past was still affecting her. She would zone out in class. She couldn’t stand being in an elevator with a man. She would flinch when someone would pat her back in school. She thought she was different or not normal, a common thought of child victims of sexual abuse, who often think they’re broken.
Then Michelle also began group therapy. “Before group therapy, I thought it was all my fault,” Michelle says. “I kept blaming myself and believing that maybe if I had put two pajama bottoms on this wouldn’t have happened. But then I started to understand that whatever happened, happened. It wasn’t my fault. And I have the right to not let that stop me from doing what I want to do.”
During the first session, Michelle says, she was in a room with eight girls who had similar experiences. “We all came together in that room, and at the end of the session, we told our individual stories,” Michelle says. “Five of the girls had almost the exact same story, and some had stories that were worse than mine, but we all felt and shared the same pain.”
That acknowledgment that she wasn’t alone gave her strength, she says. “You never know how strong you are until being strong is the only choice you have left.”
Julie Banks, clinical director of the Rape Treatment Center who oversees therapy services and the emergency clinic, says that specialized therapy provides children with the opportunity to process their sexual abuse in a safe environment. “There’s research that shows that trauma-focused therapy is an effective tool for children and adolescents toward healing,” Banks says. “We’ll meet the child or adolescent where they are. Sometimes it’s through talking, sometimes it’s through writing projects or sometimes it’s through art. Together, we’ll figure out the best healing mechanism for each child.”
Sometimes a sexual-abuse victim will experience symptoms of post-traumatic stress like flashbacks to the abuse and anxiety. Others may experience forms of regression, where an older child may revert to a younger self, using baby talk, for example, as a coping mechanism.
Group therapy provides a different therapeutic experience for children and adolescents, Banks adds. The groups are usually organized by age, and that’s where therapists can answer questions that may not otherwise come up, particularly for adolescents. “We get a lot of questions about sex and body image, questions about virginity or about sexual orientation,” Banks says. “We try to provide them a space for addressing their concerns. Sometimes they will come up with medical questions, so we’ll bring in a nurse practitioner.”
It also helps children and adolescents to realize that a person cannot tell from looking at another person whether or not they have been sexually abused, Banks says. “Quite honestly, the power to be able to look at someone who looks similar or different and realize that it isn’t evident in any way is significant for them.”
Part of Stuart House's mission is to give this too-often hidden form of child maltreatment more visibility. “Our culture tells these children to be silent about something that is painful and destructive and shaming,” says Viola Davis. “Stuart House gives them a place where they can feel safe to tell their truths and find hope and healing.”
Abarbanel has made it her life’s work to make the voices of these children matter. “There are a lot of people who find it too painful, too frightening, too uncomfortable to embrace this issue,” Abarbanel says. “This is at the core of the problem. For decades, the sexual abuse of children has been called ‘an unspeakable act’ — by the press, by professionals, in book titles, by the lay public,” she continues. “Language matters — it sends a message, it shapes and reinforces attitudes and stereotypes and it influences behavior.”
These children, Abarbanel says, “need to speak their truths — both to stop the abuse they are enduring and to heal. They must be heard.”
Michelle, now a thriving young adult who is working to support herself while attending college, says that Stuart House gave her back her life. She has her own apartment, is in a healthy relationship with a boyfriend and has plans to pursue a graduate degree in psychology with the thought of someday helping others like herself. “I used to smile to hide from other people that I felt broken inside,” Michelle says. “Now I smile because I have hope — hope in my heart and hope for my future. Stuart House turned my life completely around. It gave me what all children should have: security, love, support and protection. It gives you back the life that you dreamed of, the life that you should have. I learned I can count on people and that I am not alone.”
