Teresa NjoreMedical Social Worker/ Trauma counsellor

Department of mental healthKNH

Demographic variablesName- Mary (not her real name)Age- 10 yearsSex- femaleEducation – std 4Residence- KiberaNext of kin- Mother

ReferralThe client was accompanied by her mother a

community peer mentor and a police officer.Presenting complaint- Presented with emotional distress.Pain in her genital region and back pain.Pain while passing urine or bathing.

PC cont;Mother reports that she was abusiveRuns away from schoolSteals money to pay for video showsComes to the house late

History of the presenting complaintAt a round 9am the client had gone to the

video show.Went to the toilet, a man followed her and

grabbed her and pushed her into un occupied room.

He covered her mouth with a piece of cloth, undressed her and sexually abused her.

HPC cont;A neighbor who had seen them go in followed

them and found her being sexually abused.He raised an alarm and the perpetrator was

arrested and locked up in police cells.Brought to KNH by the police officer a peer

mentor and her mother who was very drunk.Put on PEP and STI prophylaxes.Admitted in ward 4 A.

Past sexual historyHad previously been sexually abused two

years back at Mwingi by a farm worker.She reported to her aunt who is a ‘herbalist’

and who washed her with some ‘medicine’.The matter was not reported to the policeIn 2012 she reported to have been rescued

from a boy who wanted to defile her at Kibera.

7yrs

60 yrs

10 yrs

26 yrs

Emotional relationshipDuring therapy she portrayed a negative

attitude towards her mother.She reported that her mother beats her up if

she cooks and puts too much salt in food. Declined to have her visit her in the ward.In therapy she reported that her mother likes

the younger child more than her.She reported that she’s hostile towards her.

Social historyClient has never taken any substances of

abuse.Mother sells and drinks alcohol (chang’aa).

Personal historyBorn at Pumwani hospital on 07/08/2001.Born through C/SWeighed 3.5kg; breast fed wellSat at 6monthsWalked at 1 year two monthsWas friendly to strangers

Personal history cont; Started school in the rural area (Mwingi), she

came to Nairobi to join her mother. Dates not remembered.

While at Kibera she joined a local private school

Mental Status ExaminationAppearance- untidy, unkempt, fearful and

could not maintain eye contactRapport- she was able to warm up to the

therapistMood- normalAffect- consistent with the moodForm of speech- audible and coherentPerception –no hallucinations or delusions

MSE cont;Thoughts - normalCognition functions-Memory- immediate, recent , past- goodConcentration –poorIntelligence – normal IQOrientation- well orientedJudgment-normalInsight- present

Collaborative historyMother reported that she was abusive and

could defy her rule.She reported that she was tired of staying with

the client.She also reported that she could steal money in

order to attend video shows.In the ward the nurses reported that she was

quite friendly and popular with other children.Examination under GA indicated broken hymen,

Biopsychosocial formulationPredisposing factors-Living in the slum-Child neglect-povertyPrecipitating factors-Selling illicit brew in their house-Visiting video center(pornography)-Being out of school most of the time

Biopsychosocial formulation cont;Perpetuating factors-Mother being alcoholic.-Conflicted relationship with the father and

step father.-Exposed to irresponsible sexual behavior of

the mother.

Cont;Protective factors-Initial rescue from the unsafe environment.-Came for counseling.-Attends group therapy.-She is in a shelter.-She is in school and therefore interacts with

other children.-Improved spirituality.

Multi Axial AssessmentAxis 1- child sexual abuse (v code)

Conduct disorderAxis 11-NoneAxis 111- pain in her genital regionAxis 1V - child defilement -Mother alcoholic and selling chang’aa in the

house, - mother joblessness and poor -losing her biological father -mother bringing men in the house Axis V GAF- -51-60

Management plan Admitted in ward 4A where she was taken to

theatre for examination under GAPEP and other treatment were given in the

wardShe was placed in a shelter, and attends a

nearby primary school. While in the ward she was taken through

several counseling sessions. (TFCBT)She is brought for group therapy once every

month

Treatment outcomeShelter reported that she is well behaved girlSchool performance – above average She is a happy and confident girl.

Future plansRehabilitate her mother-Engage other relatives in therapy (aunt)Work out to reintegrate with her family

Success so farThe 25 years old perpetrator arrested

immediately.Accepted the charges immediately initially

but later denied.Several court proceedings.On February 18, 2014 he was given a life jail

term.

Thank you