Preventing Sexual Violence
An Educational Toolkit for Health Care Professionals
WEB VERSION

Introduction
What Is Sexual Violence?
How Do I Prevent It?
Overview of Web version

Tools

Conclusion


Sexual Violence Prevention Toolkit
Preschool Visit Vignette Script

Focus:  No secrets/open communication
Scenario:  Well-child visit with 4-year-old girl (Maisey) and her mother (Mrs. Hill), who is recently divorced from Maisey’s father

Green light
Discussion with mom about what is going on at home and preschool; normal developmental stages of preschool children, importance of open communication with child

Dr:                   Hi, Maisey!  Hi, Mrs. Hill.  How are things going?
Mrs. Hill:          Fine.
Dr:                   So is Maisey in preschool these days, or doing anything else outside home?
Mrs. Hill:          Yeah, she’s in preschool 3 days a week.
Dr:                   Does she enjoy it?
Mrs. Hill:          Yeah, I guess.
Dr:                   Well, what does she tell you about it?
Mrs. Hill:          She says it’s fine.
Dr:                   Anything else?
Mrs. Hill:          She doesn’t talk about it much.
Dr:                   You know, a lot of adults, myself included, have this problem talking to kids.  Sometimes they just don’t know what we want them to say.
Mrs. Hill:          Yeah, but once she gets started on a story, she won’t stop.
Dr:                   Exactly!  So the trick is to get her to tell stories.  Often it’s best to ask her a question that leads her into telling a story.  The question should be fairly specific, like, “What did you have for your snack today?”  Once we ask a question that triggers some specific memories, then it is easier for a child elaborate with a story or explanation.
Mrs. Hill:          I guess I can try that.
Dr:                   Then the trick is to listen.  Just pause and give her brain a chance to work a bit, instead of jumping in with your thoughts.
Mrs. Hill:          OK.
Dr:                   One of the things that everyone in pediatrics agrees about is that open communication between kids and parents is the best defense against all sorts of bad things as they get older.  And it really starts with these little things now, and Maisey knowing that you’ll give her a chance to be heard.

Yellow light
Mom talks about a discussion with Maisey that bothered her; leads to further discussion of need for communication, discussion of media

Mrs. Hill:          That makes sense, but sometimes she says things that just leave me scratching my head, and I don’t know how to respond.
Dr:                   Oh, yeah?  Can you give me an example?
Mrs. Hill:          Well, just the other day, I was sitting around watching TV, and out of nowhere she asked me, “Do you think I’m sexy?”
Dr:                   What did you do?
Mrs. Hill:          I told her that a 4-year-old had no business worrying about whether she’s sexy.
Dr:                   How did she respond to that?
Mrs. Hill:          She just shrugged and went back to playing.
Dr:                   Where do you think she came up with that question?
Mrs. Hill:          I have no idea.
Dr:                   Well, how do you think you could have found out?
Mrs. Hill:          I guess I could have listened a little bit more and asked her a question.
Dr:                   Excellent.  Sometimes asking questions can be very useful, but it’s important in a situation like this to make sure the questions aren’t too specific.
Mrs. Hill:          What do you mean?
Dr:                   Well, when someone says something that perplexes me, I often flip it back to them. 
Mrs. Hill:          How?
Dr:                   So, for example, do you think you might have learned something by asking Maisey something like, “Well, do you think you’re sexy?” or “what does ‘sexy’ mean?”
Mrs. Hill:          Yeah, I guess.
Dr:                   So this might have been one way to handle the situation.  There are other things we can think about here as well.  For one, what were you watching on TV?
Mrs. Hill:          American Idol.  But she wasn’t really watching it; she was really just in the room playing.
Dr:                   OK, well, you know TV is more than wallpaper.  It’s one of the ways kids see how the world works.  So even if it seemed like she wasn’t really watching, do you think she could have been absorbing certain things about the value society places on physical appearance and sexiness?
Mrs. Hill:          I guess.
Dr:                   It can help to think about what you’re watching and how it seems through the eyes of a 4-year-old.  We do know they will often mimic the language and behaviors that are around them.
Mrs. Hill:          That makes sense.  I can start paying more attention to this.

Red light
Mom talks about some additional concerning behavior; leads to discussion of recent divorce and Maisey’s adjustment.

Dr:                   I should also ask, has Maisey done anything else that raises concerns?
Mrs. Hill:          Pauses, looks down.
Well, I have noticed that she seems a little preoccupied with things when she gets back from her dad’s.
Dr:                   What do you mean?  What kind of things?
Mrs. Hill:          Well, she tries to watch me while I’m in the bathroom, and I catch her trying to look up my dress.  But it’s only right when she comes back from her dad’s!
Dr:                   How long have you two been separated?
Mrs. Hill:          About a year.  The divorce was final a couple months ago.
Dr:                   How do you get along with him?
Mrs. Hill:          Fine.
Dr:                   There’s that word again.  What’s going on at his house?  Has he remarried?
Mrs. Hill:          No, he hasn’t remarried.  But he has had this succession of girlfriends.  It’s kind of like a revolving door over there.
Dr:                   What has Maisey said to you about this?
Mrs. Hill:          Nothing really.  A lot of times she’s kinda quiet when she gets back from her dad’s, but then things get back to normal.
Dr:                   Well, it sounds like Maisey might be having some trouble with this adjustment, and she may be having a hard time talking to you about it.  Even though I’ve given you a lot of communication tips today, she may still benefit from talking to someone else about this.  How about if I get you a referral to a counselor who might be able to help Maisey?
Mrs. Hill:          I guess that would be OK.
Dr:                   Alright, let’s let Maisey go out and get her vision and hearing checked, and I can get you that information.
Dr escorts Maisey to the door and asks staff person (who we don’t see or hear) to take Maisey to vision/hearing screening.
Dr:                   I also wanted to talk to you about this a little bit alone, when Maisey can’t misinterpret what we’re saying.  Most times these kinds of sexual behaviors are normal and temporary.  Sometimes children that have sexual behaviors are reacting to different situations in their environment.  For example, sexual pictures or programs or nudity can affect children’s behaviors.  Also other factors can influence a child’s sexual behaviors
Mrs. Hill:          Like what?
Dr:                   In a few cases, children that witness violence or that have experienced some kind of family stress such as abuse, illness in a family member, or neglect can have sexual behaviors. 
Mrs. Hill:          Hmm…
Dr:                   Pauses.  Is anything like this going on in your family?
Mrs. Hill:          No, just my divorce really.
Dr:                   OK, good.  It’s important to keep the different possibilities in mind especially if Maisey’s behavior is more persistent or begins to be intrusive to others.  In the meantime, try some of the things we talked about: reflecting questions, and being aware of the hidden sexual messages that TV and computers can bring.  I’ll get you the information for that counselor, and if you have any problems, you can always give me a call as well.