Childhood maltreatment — assessment, reporting and TF-CBT (MEQ)

(i) Safety and reporting. Do not discharge the child to a home where the alleged perpetrator retains access. Notify the statutory child-protection authority (and police pathways as directed) on the basis of reasonable suspicion — mandatory reporting duty under local law. Protect younger siblings. Arrange paediatric/forensic medical assessment via authorised pathways. Document verbatim disclosure, actions and times. Do not promise absolute confidentiality. Do not begin trauma narrative homework while environment remains unsafe.[2][3]

(ii) Assessment. Trauma-informed stance (safety, trustworthiness, choice, collaboration, empowerment). Private interview of the child without the stepfather; open non-leading questions; verbatim notes; collateral from aunt/school. Assess suicide/self-harm, dissociation, sexualised behaviour, substance use (if any), developmental history. Measures: age-appropriate PTSD scale (e.g. CPSS/UCLA PTSD RI) plus depression/function. Capacity/developmental competence concepts for consent to care; multi-agency strategy meeting.[2][5]

(iii) Formulation/diagnosis. Maltreatment exposure: chronic sexual abuse (commission) with likely household dysfunction (minimising carer, IPV risk). ACE domains accumulate risk but are not a diagnosis.[4] Working psychiatric diagnosis: PTSD (trauma-linked intrusion, avoidance, hyperarousal, impairment) with shame-based negative self-concept; consider broader complex developmental features. Differentials: depression, anxiety, attachment disturbance — comorbidity allowed. Not primary psychosis without other features.[2][3]

(iv) Psychological plan. After safety secured and non-offending caregiver engaged (aunt/mother if protective), offer TF-CBT with PRACTICE: Psychoeducation and Parenting skills; Relaxation; Affective modulation; Cognitive coping; Trauma narrative and processing; In vivo mastery; Conjoint sessions; Enhancing safety. Multisite RCT supports TF-CBT over child-centred therapy for sexual-abuse-related PTSD symptoms. Narrative dosage can be tailored; do not use endless stabilisation to avoid all processing once safe.[1][7]

(v) Medication. Not first-line sole care. If severe comorbid depression/anxiety or residual PTSD symptoms after/alongside therapy access issues, consider specialist-supervised SSRI (adult PTSD evidence includes sertraline; paediatric dosing individualised — exam example language: start low e.g. sertraline 25 mg orally daily with early review for activation/suicidality, titrate carefully). Monitor mood, sleep, GI/sexual effects; never replace protection or TF-CBT.[2][6]