Transcript for
Supporting children who have experienced sexual abuse

Sophie McEvoy – (00:00): 

One of the first things they need to hear is that they are believed. That it was a good idea to share what they’ve shared with you. And that you might have things you need to do, but you’re going to talk that through with them before you do it. 

(00:11): 

So it’s about them knowing they’re heard, they’re believed. You understand this might be hard, and we’re going to take the next steps together. 

Narrator (00:21): 

Welcome to the Emerging Minds podcast. 

(00:26): 

This podcast is recorded on the unceded lands of the Kaurna people of the Adelaide Plains. We pay our respects to the traditional custodians and to all Aboriginal and Torres Strait Islander peoples, their ancestors and elders past, present, and emerging from the different First Nations across Australia. 

(00:42): 

This episode discusses practises to support children who have experienced child sexual abuse. Please keep your own wellbeing in mind as you listen. And give this episode a miss if it brings up any difficult feelings for you. You can also find details of support services in our show notes. 

Dan Moss – (01:02): 

Hi everybody. My name’s Dan Moss. Welcome to this Emerging Minds podcast on working with children who have experienced child sexual abuse. 

(01:10): 

It’s my very great pleasure today to introduce Sophie McEvoy to this podcast. Sophie, welcome. 

Sophie McEvoy – (01:16): 

Yeah, thanks for having me. 

Dan Moss – (01:17): 

So Sophie’s a therapist and team leader working with the Child Sexual Abuse Counselling Service and rebuild, counselling for victims of crime at Relationship Australia, South Australia. 

(01:27): 

Sophie has previously worked within the adult mental health sector and within the family and domestic violence sector, working with both victims and perpetrators of sexual and physical violence. 

(01:37): 

So welcome today, Sophie, and this is not the first time we’ve met. I’m really looking forward to this conversation to talk about some of the strategies that you use to work with children who might be feeling complicit or to blame, or a sense of shame about their experience of child sexual abuse. 

(01:59): 

So maybe if we start off, could you tell me a little bit about your role at Relationship Australia, South Australia? 

Sophie McEvoy – (02:05): 

Yeah, for sure. So like you said, I’m the team leader for rebuild, which is the counselling service for victims of crime as well as for the CSA service. So that’s counselling for child and adult victims of child sexual abuse, and also their families and caregivers and others who might be involved. 

(02:22): 

So I take really two roles there. I’m a counsellor in the team as well, so I’m still engaged in the practise with children and adults. And I also am a team leader, so I do a lot of the day-to-day management and making sure things are running smoothly or as smoothly as they can. 

Dan Moss – (02:38): 

Tell me what are some of the ways that children’s experience of sexual abuse are affecting them when they come to first meet you? 

Sophie McEvoy – (02:46): 

There can be such a variety of presentations, and I guess that’s one thing in being here today is wanting to get across that these kids are just individuals like any other clients we might be working with. And yet, they’ve been through some really tricky stuff. Maybe will have some similar outlooks, but they do have a whole range of things going on for them. 

(03:09): 

And the first thing we want to do really is treat them as that individual that they are. But some of the things that we might notice when kids are coming in is that they might be holding responsibility for things that aren’t theirs to hold. They might be feeling as though they’re to blame for what’s happened. Or perhaps, for the repercussions of what’s happened in their lives. 

(03:27): 

What we know is it’s not only the incident of the trauma itself that has an impact, it’s the fallout in family structures and in social networks. And the loss of family and friends basically, from something like this coming out that can have a big impact. So they might also be dealing with those feelings and situations in their lives. 

(03:47): 

There might be some sense of identity crisis happening for them. Who am I now at this age with these experiences in my life? What does that mean for me going forward? Lots of confusion. And some anxiety, especially around themes such as trust. Lots of loss of trust in the people in their lives or not knowing who and how to trust going forward. So maybe some of the big things we see with kids coming in. 

Dan Moss – (04:14): 

And I suppose for lots of children, they’ve had ways that these anxieties or these worries have been named by other adults in their lives or other professionals. As having particular diagnoses or being naughty, or being mischievous or being bad. How does that come about in the way they are or even their willingness to meet with you? 

Sophie McEvoy – (04:40): 

Absolutely. We see so many kids coming in with a stack of labels. Coming in already feeling like they’re doing things wrong on the day to day and they’re not acting right. And they might have a long list of diagnoses behind them, but aren’t really even sure where that’s come from or what that’s about. 

(04:57): 

So for kids, what we want to do is sit down with them, treat them as an individual and get to know, “Okay, what’s important to you? What’s happening in your life that’s tricky at the moment. What can we put on the table here between us that might be impacting you more than other people around you might even be noticing.” 

(05:15): 

So it’s about breaking down some of those labels, diagnoses, or whatever they’re carrying in with them. And coming back to, what’s going on for you right now? What’s important for you in this moment for us to address together? 

(05:28): 

And then coming to kids who might’ve been taken around to many different counsellors, many different GPs, psychologists, whoever it is, and had to tell their story again and again. Involved in the criminal justice process, perhaps. They might be reluctant to come and see us. 

(05:45): 

We really want to name that and we want to put it on the table to begin with. We want to give them the chance to tell us how they’re feeling. We don’t want to shut down that feeling they have of, “I don’t want to be here.” We don’t want to say, “Oh, it’ll be great. It’ll be really fun.” Might not be great, might not be fun. We want to listen to that. And we want to hear why they don’t want to be there, where that’s coming from. And really work with them alongside that. 

(06:10): 

For us, a big part of that is letting kids know that it’s a voluntary service and really sticking with that. If a kid really doesn’t want to be there. They’re telling us that again and again. They’re telling the parent that again and again. It’s then a conversation with the parent around, “Well, what are we doing here? In the long term, is it helpful for this child to be made to come and be here with us?” 

(06:31): 

So that could be one pathway we go down. Alternatively, if we can get to know the child often we start to build rapport and connection. And they start to want to be there with us and to want to explore their life in different ways. 

Dan Moss – (06:43): 

So it’s quite important really, from what you’re saying, Sophie, that children have the chance to describe the effects of the problems in their life in their own ways. Using their own ways of meaning making. 

Sophie McEvoy – (06:56): 

Definitely. And using different ways of getting this across to us really, because we might be used to talking and putting things into words. But they might need to show us that in different ways. Whether that’s through play using doll houses or a sand tray or whatever other methods of play you might be engaging in with a child. Using that to show what’s going on in their life or what has happened and what they might need. 

(07:20): 

Or perhaps using art therapy approaches as well can be a good way to open things up for kids. And even to get to know their life a little bit more. Starting out with drawing. What’s going on for them? What’s important? Who’s around them? And getting to know them in that way rather than needing to sit face to face and have that conversation. 

Dan Moss – (07:41): 

And so when you’re having these conversations and getting to know children, how do you make decisions about what to ask them? And actually, what parts of their trauma experiences or events do you ask them about without unnecessarily causing distress? 

Sophie McEvoy – (07:56): 

Yeah, good question. 

(07:57): 

I think this has to be quite intentional and also informed. Something we think is important is if there is a safe and supportive caregiver or parent in the child’s life is meeting with them first. To fully understand what’s been going on for this child and getting a bit of context ourselves. Not coming in completely blind to the situation. So perhaps having some background knowledge before you even start is important. 

(08:21): 

And then giving that power about what we talk about to the child in a way that they can understand. So we will always tell the child who we are and what we’re there to do. We’ll make sure that the child, in advance of coming, is spoken to by their parent. And has a very clear idea of what this service is and why they’re coming to it so that they’re prepared. 

(08:43): 

They’re not just told, “Oh, you’re going to go chat to someone about life.” And they show up and we tell them we’re the Child Sexual Abuse Counselling Service, or you’re here because of family and domestic violence. So really preparing the child to talk with us in that way. 

(08:56): 

And then I think I was saying before, coming back to what as an individual does this child think is important about this experience? What are they carrying with them day to day that is making them feel confused or upset or sad? And coming back to digging deep through that stuff with them and getting to know them as an individual and what their needs are really. 

(09:17): 

We will come in with certain ideas in our own heads, don’t get me wrong. We might be thinking about power dynamics in their life and how they’ve played out. And maybe how they might come to understand them going forward. So we might want to think about talking about adult power and child power. Who has what responsibility? How does that play out day to day? 

(09:37): 

We can do that in fun ways as well. We can do that in child-friendly, developmentally appropriate conversation. Asking funny questions like, “Oh, so did you drive here today? Do pay for the taxi on the way here?” Fleshing out, “Okay, so mom and adults and those around us have a lot of responsibility and children should have less of that responsibility.” 

(10:00): 

And some of the other things also alongside that are big feelings they might be carrying that we want to look out for. Shame is a huge one for kids and self-blame, and really holding onto feelings that they should have done more. They should have known what was happening. They should have intercepted. All of these feelings that show up for kids. 

Dan Moss – (10:18): 

Because children might not generally use words like shame or self-blame. 

Sophie McEvoy – (10:24): 

No. 

Dan Moss – (10:24): 

So how do you get a shared understanding of those feelings? How do you get children to be describing those to you? 

Sophie McEvoy – (10:34): 

I think you’ve got to be doing some double listening from the outset really. You’re listening to what they’re saying, but you’re listening to what’s beneath it as well. You’re thinking, okay. If a kid’s saying to me, “Mom was always getting hurt and I didn’t do anything to stop it.” We’re listening for the underlying idea there of I should have been doing more. And that’s something we can pull out and help them understand as an underlying feeling of shame. 

(10:57): 

And shame is a big concept, but it’s a really useful one when we’re talking about shame that’s not ours to hold. And giving that back to the people who should be holding it. That’s one of the ways we might talk about it with kids is fleshing out, “Okay. So you feel like you should have been keeping everyone in your family safe.” 

(11:18): 

But there was an adult with a lot more responsibility and power who was making these people unsafe. So how can we make sure we help the child know that the responsibility for keeping people safe doesn’t lie with children in the house, it lies with the adults. 

(11:32): 

And I’m thinking about a particular kid I worked with who ended up drawing the big shame monster that had been standing behind them in their life and dominating them with all these feelings of should’ve, could’ve, would’ve. And they managed to show that in a very creative way. And we worked on moving that shame monster further away from them over time. 

Dan Moss – (11:51): 

So this was a theme that you stuck with with this child? 

Sophie McEvoy – (11:55): 

Yeah, definitely. And if you can language it in a way that kids understand, then you can come back to it again and again as it shows up throughout the work. 

Dan Moss – (12:04): 

And I’m just thinking about that statement that child made around I should have been doing more to keep my mum safe. And you’re talking about double listening. That also talks a little bit about that child’s values or what that child might want for their mum as well. 

Sophie McEvoy – (12:21): 

Yeah, yeah, definitely. And for themselves. And maybe even a little bit about what is life like now that isn’t in your life or that things have changed. And how can we draw some conclusions about what needed to change in life in order to be in a place where their values are upheld. Or even just their safety is upheld. Who needed to be out of the picture for them to feel safe and be safe. 

Dan Moss – (12:44): 

Do you find that children’s confidence in having these conversations increases as you begin to draw pictures with them or help them find the right words that matches their emotions or feelings? 

Sophie McEvoy – (12:57): 

Yeah, yeah, absolutely. And as they come up with the idea, we can bring a lot of thoughts and feelings into the room. But if they’re not connecting with them, they’re not going to run away with them. Whereas if we can talk in a really broad and open way and use their own words to connect with what we think is sitting underneath the feeling, then they can take that away with them. 

(13:17): 

I’m thinking of a different child now who came up with this big acronym about how she was feeling. And I can’t remember the word. I’m sure she can. But she had a different feeling attached to each letter at the beginning of this word. And every session she’d come in and she’d tell me, “I’ve been feeling much less of this because of this, this and this.” And so the idea that she came up with let her connect to that and let her run away with it and do the work herself really. 

Dan Moss – (13:41): 

Yeah, right. So you’re helping that child develop a sense of energy in the session or a sense that this is something they value this conversation in their life? 

Sophie McEvoy – (13:51): 

Yeah, exactly. And that it’s their space. While we are services for very specific situations, that doesn’t mean we can’t have broad conversations as well about how other things in their lives are impacting them. 

(14:03): 

Because we know for kids, school, relationships, friendships, all of those things are having a huge impact as well. So if we put that in the not-our-business box, we’re not going to be able to build the full relationship and get a full picture of what’s happening for this kid. So bringing those things in as well and making sure you’re working with the whole child. 

Dan Moss – (14:23): 

And I suppose too, so often children who’ve experienced physical or sexual violence are often seen as passive or solely as victims of that experience. And that can have an impact on them as well. Can you talk a little bit about how you bring that child’s sense of know-how or their own values or preferences or strength into the room? 

Sophie McEvoy – (14:43): 

Yeah, definitely. That’s a really good question. 

(14:46): 

I’m thinking about practitioner mindset and models you might into the room with in your head that you won’t necessarily talk directly with the child about. But one of the main models we work from as a team is resistance and response-based practise. So knowing that in any form of violence or abuse, the victim is always resisting and responding in some way. And it’s coming back again to that listening for things that are a bit unsaid. 

(15:13): 

So you might hear from a child, “There was a violent incident, this was all happening. I went and got my little brother and took them and we hid under the bed.” And we can hear that just as a story or we can hear that as an act of resistance to what is happening in the house and an act of protection for that little sibling as well. 

(15:33): 

So it’s really making sure we’re not seeing kids as passive in these situations or adults. They never are. They’re always finding amazing coping strategies. And naming it as that, particularly I think as kids get older as well. Teenage kids being able to name this is how you’ve coped rather than these are some maladaptive strategies you’ve got to get through. It’s like, “This is what’s helped you. And moving forward, how can we make that work for you in a better way?” 

Dan Moss – (16:02): 

For practitioners, and there’ll be lots of generalist practitioners listening who don’t specialise in physical or sexual abuse. How can they, where they might suspect or identify signs of abuse, offer the opportunity for children to talk about some of their experiences without pressuring them into disclosures when they’re not ready? 

Sophie McEvoy – (16:27): 

I think shame, particularly in relation to child sexual abuse, is so huge and leads to so much silence. And so these topics are often not spoken about specifically with kids. 

(16:40): 

So for generalist practitioners, I think a huge part of it is coming back to open conversation and being the person who can be there and say, “Oh, I heard this. I’m wondering if something might’ve happened in your life that you haven’t been able to talk to anyone about? Or you’ve said a few things that make me think you’re feeling unsafe at home. Is that right? Do you want to tell me more about that?” 

(17:03): 

Just stepping into opening up conversations and letting the child know that this is a safe space. This is a place where they can talk about what’s going on in their life. And we will work together to find some solutions and some resolutions around this stuff. 

(17:18): 

Yes, so I think for generalist practitioners, there are a few things to come back to about what kids might benefit from hearing in those moments when you’re having those conversations. Especially, when something’s happened where perhaps they’ve told someone before and haven’t been believed or they haven’t yet had an opportunity to tell anyone. 

(17:37): 

One of the first things they need to hear is that they are believed. And that it was a good idea to share what they’ve shared with you. And that you might have things you need to do, but you’re going to talk that through with them before you do it. So it’s about them knowing they’re heard, they’re believed. You understand this might be hard and we’re going to take the next steps together. 

(17:57): 

Knowing that you’re not there to gather information, to gather evidence, anything like that, obviously good notes and mandatory reporting. But you are not going to take that next step that say the police or someone else might take. You’re there to really ensure that this situation right now with this child feels safe, comfortable, and really that the child feels believed in that moment. That’s the main thing I think with the first disclosure in that setting. 

Dan Moss – (18:25): 

So really all of some of those skills that practitioners use in their everyday lives with children. 

Sophie McEvoy – (18:31): 

Yes. 

Dan Moss – (18:32): 

They become even more important I suppose, after disclosure of child sexual abuse. 

Sophie McEvoy – (18:36): 

Yeah, yeah, exactly. And just coming back to relationship, like I said, if the child is disclosing to you, there’s a relationship there already that they’re coming back to. 

Dan Moss – (18:46): 

So moving our focus a little bit now to your work with parents, and I understand you do quite a bit of that in your role at Relationship Australia, South Australia. How do you work with parents who might be experiencing those same range of emotions that we talked about in terms of shame or guilt, or even anger, about their child’s experience of sexual abuse? 

Sophie McEvoy – (19:08): 

I want us to come back to understanding again. I think parents, they often get a lot of frustration directed at them from perhaps practitioners or services, to fully understand and take on a really difficult situation and just be able to roll with it. So we want to be a space where parents can maybe talk about some of those trickier feelings they’re having. Trickier relationships they’re having. 

(19:36): 

One of the big things we see is sibling abuse. So there might be two siblings from the same family and one has perpetrated sexual behaviours against another. And in that situation, as much as we’d love for it to be a black and white, cut and dry situation for that parent to respond to, it’s really not. 

(19:54): 

And we want to tap into our empathy for that parent in that moment and have an open conversation about what’s going on for them. What are some of those more complicated feelings and how have they been managing that? So we don’t really want a parent to ever feel shut down or they can’t talk about that in that space with us. 

(20:12): 

So if we can, holding space for the parent. If you have capacity for that in your work, holding the space for them. But then also coming back to, “Okay, in the context of what’s happened, there’s space for you here and for your feelings. What space does the child need and what are their feelings? And how are you going to respond to them given the complexity that you are also feeling? How can you take a breath, take a moment, understand what your child needs? And still provide that even though this is a really complex time?” 

(20:41): 

So it’s a bit of that restorative stuff, high support and high challenge. We want to really support parents, understand them, connect with them, but challenge them to meet their children’s needs at the same time. 

Dan Moss – (20:53): 

And I was really interested in that idea about letting parents express some of those. I suppose that’s quite human, natural reactions after some of these experiences and how they might be feeling about their children or others. And giving them a place to express that without policing that is really important. 

Sophie McEvoy – (21:13): 

Yeah, absolutely. And we might drop little bits and pieces in over time that we feel are important. If there’s doubt coming from a parent about what’s happened. We might just want to drop in, “Oh, what we know is children don’t really lie about this kind of stuff. And it really does sound like your child has been through something here. So we do tend to believe kids in this space, but I understand it’s pretty complex for you at the moment. Let’s talk that through.” 

(21:38): 

So it’s not shutting it down, it’s not judgmental. But it is still reinforcing we need to believe and support the child whilst understanding you are having some complex feelings here. 

Dan Moss – (21:50): 

Without adding to the parent’s already sense of shame or guilt. 

Sophie McEvoy – (21:57): 

And shame, that’s probably where a lot of this feeling is coming from. Let’s be honest. The desire I think for parents to say, “Oh, that can’t of happened.” I think a lot of that comes from a shame. “That happened under my care. Under my watch in my house.” So it’s like a bit of a reactive shame moment. And being able to hold that for a parent and work through that with them is going to be the best thing for them and for their child in the long run really. 

Dan Moss – (22:21): 

So within this, I suppose the next part of that, your work really and work with parents, is to help them to provide those consistent, positive reinforcing messages for their child. Which are needed as their children recover hopefully, from the effects of child sexual abuse. 

Sophie McEvoy – (22:38): 

Yeah, definitely. They’re the person who’s going to be there most of the time. And that is always something we talk about in that first session with parents. We might have four nightly or three weekly sessions with your child going forward for a little while, but you’re going to be there from now and well past when we step out of their lives. So you are going to be that consistent figure for them. 

(23:00): 

So that conversation is a bit about what will you need to keep going in that space and to keep hearing potentially further disclosures and responding to them. Or even just responding to big behaviours. And a part of it is what do you think your child’s going to need for you throughout this? And getting to know how the parent sees the child and how they might be able to respond. 

(23:21): 

And there’s some good stuff around developmentally appropriate language with this stuff as well. Because a lot of parents haven’t had to have a conversation regarding sex, sexuality, or any of these complex topics at the time these disclosures are made. 

(23:35): 

So we can really help with just some languaging around how you might talk to a smaller child about some of this stuff. And using the right words for private parts. And all of those, I guess we’d think of them as parenting skills, parenting conversations, we can upskill parents with at the outset so they can do that going forward. 

Dan Moss – (23:57): 

You talked about some of those exercises that you do with children around making power overt and really thinking about adult child responsibility. Is that sometimes important with parents too? I suppose a lot’s known about the way that sexual abuse can be minimised or blame can be shifted. And that can affect everyone in society. And I suppose parents don’t see it outside of that either. 

Sophie McEvoy – (24:21): 

Yeah, yeah, absolutely. And those conversations can be quite upfront with parents as well about the impacts on both them and their children of that shifting blame and the shifting responsibility. And how to identify when that might be happening. But also broadening out to think about with parents, and with kids actually, but using different language, how this happened. And that encompasses perpetrator tactics and grooming behaviours. 

(24:49): 

And being able to flesh out, “Okay, so it was really difficult for you to know that this was happening in your house and there were reasons that that happened. Let’s think about those. What made it hard? Okay, you were working two jobs and their stepdad was not working. So you were supporting the whole house, out all the time, really busy. Must have been hard to stay connected to everything happening at home.” 

(25:13): 

So it’s about making visible what the perpetrator has made invisible really. And with parents, you can have those conversations in a pretty upfront way over time. 

Dan Moss – (25:23): 

I suppose for some parents, they still have some relationship with the perpetrator, which I suppose makes those conversations even more challenging. 

Sophie McEvoy – (25:34): 

Yeah, definitely. I think that’s a whole other world to navigate. But again, if we have the chance to be in a room with someone, we want them to feel not as though we support everything they’re doing, but as though we support this conversation. And just broadening it out. We’re not here to judge. We’re not here to shut them down. We’re here to think about what’s going to be best for their child. It comes back to that centering the child in the space. 

Dan Moss – (25:58): 

So we’ve talked a little bit about non-specialist child sex abuse practitioners or more general practitioners. As we know in the recent Australian Childhood Maltreatment Study would evidence this, that practitioners are increasingly seeing children or young people or parents who have been affected by child sexual abuse. What tips do you have for these practitioners in the work that they do, particularly with children? 

Sophie McEvoy – (26:25): 

It definitely is a growing area of need and of expertise amongst the general practitioner population as well. 

(26:32): 

I think really one first step people can do is getting the politics of abuse stuff straight in their own heads. And that comes back to all of these things we’ve been talking about today, shame, responsibility, self-blame, grooming. How this stuff happens in our society. If we can understand that a little bit better, then we can help our clients understand that as well. 

(26:56): 

So a first step is knowing to an extent why and how these things happen. And then I think it’s validating that, “Yeah, this is big stuff to talk about.” For yourself as a practitioner, it’s going to feel uncomfortable probably. The first five, 10, however many times I talk with a client and they talk about sexual abuse, and I feel a bit like, “Oof, am I the person to respond to this?” 

(27:21): 

And it’s okay to have those doubts. It’s okay to feel a bit worried. But coming back to what you know about your work and what context you’re working in, and the skills that you have, and just applying them in that context. 

(27:34): 

It is specialist work, but if we think about one in three girls and one in five boys are impacted by child sexual abuse? Actually, we’re all doing this work in this space. We’re all having these conversations. And getting some good support around it if it’s coming up a lot in your work, if there’s the capacity for that. 

Dan Moss – (27:52): 

You are both a practitioner, as we’ve spoken about and a supervisor, so you’re a good person to ask about this. What role does supervision play in helping professionals to work supportively with children who’ve experienced child sexual abuse? 

Sophie McEvoy – (28:07): 

Supervision’s huge. It’s so important. I really am so grateful to my organisation for having such good supervision structures. 

(28:17): 

I think it’s important to have an individual supervisor who you can feel quite open with about your concerns working in this space or any other space. And using that space well. When you’re in your own supervision, feeling like you can bring up those worries or concerns or gaps you feel there are in your knowledge. 

(28:35): 

But I think peer supervision’s really important too, because if you are having a worry about working in this space, someone else in your team is probably having that worry too. So being able to connect and use each other’s skills to grow together in this space is really important. 

(28:51): 

I think coming back to, you shouldn’t be doing this work alone. This shouldn’t be something you think is just sitting with you in your space. And so whoever you can connect with and broaden your knowledge, that’s going to be an important step to take in growing in this work. 

Dan Moss – (29:06): 

Sophie McEvoy, thank you so much for joining us today and letting us know a little bit about your work in supporting children who have experienced child sexual abuse. Such important work. And you’ve been able to offer us some really great and wise insights. So thank you for joining me today. 

Sophie McEvoy – (29:26): 

Thank you for having me. 

Dan Moss – (29:26): 

And thank you to everyone for tuning in today for this podcast on working with children who’ve experienced child sexual abuse. We look forward to next fortnight when we’ll join you then. Goodbye for now. 

Narrator (29:39): 

Visit our website today at emergingminds.com.au to access a range of resources to assist your practise. 

(29:47): 

Brought to you by the National Workforce Centre for Child Mental Health, lead by Emerging Minds. The Centre is funded by the Australian Government Department of Health, Disability, and Ageing under the National Support for Child and Youth Mental Health Program.