Pergamon

Child Abuse & Neglect, Vol. 19, No. II, pp. 1379-1386, 1995
Copyright ~ 1995 Elsevier Science Ltd
Printed in the USA. All rights reserved
0145-2134/95 $9.50 + .00
0145-2134(95)00102-6
SPOTLIGHT ON PRACTICE
A THERAPEUTI C PRESCHOOL FOR ABUSED
CHI LDREN: THE KEEPSAFE PROJECT
R . KI M OAT E S
University of Sydney, Department of Pediatrics and Child Health, The Children' s Hospital,
Camperdown, NSW, Australia
J ANE GR AY, L I NDS AY S C HWE I T Z E R , R UT H S. KE MP E ,
AND R OB E R T J . HAR MON
C. Henry Kempe National Center for the Prevention of Child Abuse and Neglect, Denver, CO, USA
Abst r act - - Twent y- f our children attended a therapeutic preschool for physically and sexually abused children, the
Kempe Early Education Project Serving Abused Families (KEEPSAFE), over a 3-year period from 1985-1988. The
program provided early education and therapy for abused children so that they could improve developmentally,
socially, and emotionally, with the aim that the children would be suitable to enter the public education system. The
therapeutic preschool was combined with a home visitation program for the child' s parents or primary caretaker,
focusing on improving the quality of interaction between the adult and child. The majority of children made develop-
mental gains at a faster rate than would normally be expected as measured by the McCarthy Scales of Chi l dren' s
Abilities and the Peabody Picture Vocabulary Test. Although all 24 children were thought at onset of intervention to
be unable to participate in a public school setting, after 12 months in the program over 79% were staffed into the
public school system eight (33.3%) into a regular classroom. Three others (12.5%) needed residential care, and two
were too young to enter public school. Even though a therapeutic preschool is expensive in terms of the high staff
to child ratio needed, it is likely to be beneficial in improving the developmental skills of abused children.
Key Words--Therapeutic preschool, Child development, Physical abuse, Sexual abuse.
I NT R ODUC T I ON
B Y T HE T I ME t he a b u s e d a n d n e g l e c t e d c h i l d r e a c h e s t he p r e s c h o o l y e a r s , ma n y o f t h e l o n g -
l a s t i n g e f f e c t s o f a b u s e a n d n e g l e c t s u c h as a g g r e s s i v e b e h a v i o r s , p o o r p e e r r e l a t i o n s h i p s , a n d
d e l a y e d c o g n i t i v e s k i l l s a r e c l e a r l y p r e s e n t ( Kl i n e , 1977) . Wi t h o u t i n t e r v e n t i o n , mo s t a b u s e d
c h i l d r e n wi l l b e s e r i o u s l y h a n d i c a p p e d at e n t r y i n t o t h e p u b l i c s c h o o l s y s t e m.
Wh i l e p h y s i c a l i n j u r i e s c a n s o me t i me s l e a d t o n e u r o l o g i c a l h a n d i c a p s wh i c h r e s t r i c t l a t e r
l e a r n i n g ( Ma r t i n , Be e z l e y , C o n wa y , & Ke mp e , 1974) , mo r e o f t e n , t h e a b u s i v e a n d n e g l e c t f u l
Received for publication October 20, 1993; final revision received May 9, 1995; accepted May 15, 1995.
Reprint requests should be addressed to Jane Gray, M.D., C. Henry Kempe National Center for the Prevention of
Child Abuse and Neglect, 1205 Oneida Street, Denver, CO 80220.
1379
1380 R. K. Oates, J. Gray, L. Schweitzer, R. S. Kempe, and R. J. Harmon
home environment replaces nurturing and stimulation of learning with unresponsive indiffer-
ence, unreasonable demands or physical attack. Such an environment produces a child whose
ability to relate to others and to use his innate developmental capacities are seriously compro-
mised. The most damaging of these delays seems to be found in social and emotional develop-
ment (Egeland, Stroufe, & Erickson, 1984; Oates, 1983; Tong, Oates, & McDowell, 1988).
Abused children feature prominently in special education classes within the public school
system, in psychiatric hospital wards, among runaway children, and in the populations of
delinquent children and violent offenders (Kline, 1977; McCormack, Janus, & Burgess, 1986;
Steele, 1982).
Abused preschool children, with their inhibited social skills and lack of trust, tend to be
difficult children to teach and their chaotic family environments are often not receptive to
intervention. The KEEPSAFE Program (Kempe Early Education Project Serving Abused Fami-
lies), which provided a therapeutic preschool and home visitation program for abused children
aged 3 to 6 years and their families, was an attempt to overcome these difficulties.
PROGRAM
The aims of the KEEPSAFE Program were: to demonstrate optimum early education services
for abused children and their families by creating a classroom setting where abused children
could improve in development, social and emotional status; to evaluate the effectiveness of
this approach by the chi l d' s developmental progress in the program; and to improve the quality
of the interaction between the parents (abusive or foster parents) and their children.
The therapeutic classroom has been a major element of the KEEPSAFE approach. It includes
elements of several educational and therapeutic methods combining environmental, communi -
cation, and behavioral approaches. Psychological as well as physical safety is emphasized to
enhance the chi l d' s level of trust, self-concept, and social skills and to create a psychologically
safe environment (Briggs, 1975). Interactions that are psychologically safe begin with focused
attention and include the safety of trust, safety of nonjudgement, safety of being cherished,
safety of owning feelings, safety of empathy, and the safety of unique growing (Briggs, 1975).
To ensure that this environment of psychological safety was maintained, the KEEPSAFE
Project has emphasized an empathic, child-centered environment where the use of nonverbal
and verbal strategies enable the teacher to j oi n the child at the child' s level through developmen-
tally appropriate communication. The educator and the child engage in a communi cat i ve
interaction rather than a didactic "t eachi ng" model. The therapeutic program included objec-
tives for behavior, communication, socialization, and academic skills for each child.
One goal of the therapeutic preschool program has been to provide each child with the
knowledge and pre-academic skills required for entry into public school so that t hey can
achieve academically. The philosophy of the project recognizes that each child is developmen-
tally unique and that social and emotional experiences can affect cognitive development.
Within this psychologically safe environment a variety of other techniques have helped
maintain consistency and reliability both within the structure of the program and for the
preschool team. These include: (a) A consistent routine that allows the child to predict the
sequence of activities and helps build the chi l d' s trust in both the staff and school; (b) limits
and rules that allow the child to feel safe by knowing that there are consistent boundaries and
consequences; (c) choice and control, providing the child with an opportunity to exert initiative
and have some control of over activities; (d) repetition of rules of safety and limits so these
become consistent and predictable for the child; (e) repetition of activities so that the child
can obtain a sense of mastery over a task or expand on it; (f) consistent staff, allowing the
child to build relationships that will endure throughout the chi l d' s placement in the program;
Therapeutic preschool 1381
(g) a case management system where one teacher is responsible for each chi l d' s case, including
providing home visits; and (h) a consistent weekly schedule when each day of the week has
a special activity planned (e.g., Monday is story day, Tuesday is cooki ng day, Wednesday is a
field trip, and Thursday is drama day). It is essential for the children and st aff that programmat i c
consistency be maintained by incorporating special activities on a regularly recurring schedule.
The KEEPSAFE pr ogr am' s basic curriculum was compatible with guidelines of the National
Association for the Educat i on of Young Children (Bredekamp, 1987). It was revi ewed weekl y
and adjusted to meet the evol vi ng needs and interests of the children.
Additionally, each child in the KEEPSAFE Program had an individual psychotherapist for
weekl y or twice weekl y sessions. This ensured that the child had one-t o-one attention from
an adult that could not be disrupted by other children or adults. Daily group therapy sessions
focused on issues such as safety and hygiene.
The parent component of the program had two goals. The first was to give caretakers
emotional support from st aff members and referrals to other psychol ogi cal services. The second
goal was to i mprove the quality of the interaction between the child and the caregiver. Home
visits, occurring twice a month, recogni zed the importance of the parent ' s relationship to the
child and focused on improving parenting skills and parent-child attachment. In the home,
time was spent helping parents become better " r eader s " of their chi l d' s behavi ors and helping
them learn strategies to become reactive rather than directive with their children. As well as
aiming for the home visits to be nonjudgmental and nonthreatening, the home visitor aimed
to be empathic about the difficulties parents face in having an emot i onal l y disturbed child in
their home.
SUBJECTS
Twent y-four children (13 females, 11 males) were enrolled in the KEEPSAFE Project over
a 3-year period from 1985- 1988. All had been sexually and/or physi cal l y abused prior to
enrol l ment and because of devel opment al delays and abnormal behaviors were j udged to be
unsuitable to enter public school. At the time of enrollment, 14 were living with at least one
natural parent, four were with relatives, and six were in foster care.
Children were referred to the KEEPSAFE Program chiefly by count y departments of social
services; a small percent age of these children and their families had been ordered into treatment
by the courts. A few children were referred by their parents or by another preschool program,
mainly Head Start. The only criterion for refusing admission was a lack of transportation
which made it impossible for the child to get to the preschool.
Evaluations
The devel opment of all children was assessed at entry to the program using the McCart hy
Scales of Chi l dren' s Ability (McCarthy, 1972). This is a well validated, wi del y used tool that
measures verbal, perceptual, quantitative, memory, and mot or skills and provides a General
Cognitive Index (GCI), which correlates well with standard IQ measures. They were also
administered the Peabody Picture Vocabulary Test-Revised (PPVT), a more narrowly focused
assessment of receptive language (Dunn & Dunn, 1981). As abused children often have diffi-
culties with expressive language and as receptive language skills precede those in expressive
language it was felt that the PPVT may provide a more sensitive measure of language in this
group. In addition, it requires less cooperat i on than ot her measures of language ability, an
important consideration when assessing disturbed children. Both tests were repeated after 12
months to measure the degree and rate of progress.
1382 R. K. Oates, J. Gray, L. Schweitzer, R. S. Kempe, and R. J. Harmon
Comparisons over time for these two tests were made using the Proportional Change Index
(PCI) (Wolery, 1983). The PCI is a numerical statement of the relationship between the child's
rate of development in comparison with the gain in chronologic age during intervention. The
PCI takes into account the number of months actually gained developmentally and the number
of months in intervention, thus offsetting the tendency to assume a one-to-one relationship
between developmental age and chronologic age.
In addition to the developmental assessments, all children were tested with the Denver Eye
Screening Test (DEST) (Sprague, 1981) and the Denver Audiometric Screening Test (DAST)
(Northern, 1981) on enrollment and discharge lom the KEEPSAFE Program.
RESULTS
McCarthy Scales (Table 1)
Al l 24 chi l dren were t est ed at enrol l ment; however, three ( 12. 5%) o f the chi l dren had
behavi ors (short at t ent i on span, distractibility, nonc ompl i anc e ) prohi bi t i ng t hem f rom c ompl e t -
i ng t he McCart hy Scal es . Three o f the 21 chi l dren c ompl e t i ng t he t est gai ned ski l l s at a s l owe r
rate than wo u l d be e xpe c t e d f or normal devel opment , wi t h a gai n o f l ess than 12 mont hs ove r
t he 12- mont h peri od and a Proporti onal Change Index o f l ess than one . The average gai n made
by t he other 18 chi l dren was 16 mont hs over a 12- mont h peri od. The Proporti onal Change
Index (a more accurate representati on o f t he rate o f c hange ) f or t he 21 chi l dren had an overal l
Tabl e 1. Developmental Progress Over 12 Months on 24 Children Enrolled in the KEEPSAFE Program as
Measured by the Peabody Picture Vocabulary Test and the McCarthy Scales of Children's Abilities
Peabody Picture Vocabulary Test McCarthy Scales
Child Gain Developmental Proportional Gain Developmental Proportional
Number (Months) Rate Change Index (Months) Rate Change Index
1 25 2.78 4.96 12 1.33 1.96
2 25 2.78 3.16 - - - - - -
3 20 2.22 4.44 12 1.33 1.73
4 21 2.30 3.38 12 1.30 1.60
5 20 2.20 2.72 18 2.00 2.25
6 19 2.11 2.37 19 2.11 1.90
7 18 2.00 2.00 6 0.67 0.70
8 16 1.77 2.76 - - - - - -
9 16 1.60 1.80 6 0.60 0.65
10 15 1.50 2.70 12 1.20 1.36
11 14 1.57 3.00 - - - - - -
12 13 1.40 2.03 12 1.30 1.67
13 13 1.18 1.20 18 1.64 1.71
14 13 1.44 1.97 6 0.67 0.67
15 12 1.33 1.26 17 1.88 1.65
16 10 1.11 1.29 19 2.11 2.64
17 9 1.00 1.33 12 1.33 1.36
18 9 0.69 0.85 12 0.92 1.00
19 9 1.00 1.19 24 2.67 4.24
20 7 0.78 0.68 24 2.60 2.71
21 7 0.70 1.15 12 1.20 1.87
22 6 0.75 0.72 12 1.50 1.92
23 2 0.22 0.28 17 1.88 2.60
24 I 0.11 0.12 24 2.70 4.15
Mean 13.33 1.44 1.82 14.57 1.57 1.92
Gain
Therapeutic preschool 1383
mean of 1.92 and a mean of 2.13 for the 18 children who i mproved. As shown in Tabl e 1,
there was a wi de variation in the amount of gain made by di fferent children. A t-test compari son
bet ween McCar t hy initial scores and scores after 12 mont hs was significant (p < .05).
Peabody Picture Vocabulary, Test (Table 1)
All 24 children compl et ed the PPVT on enrol l ment and aft er 12 months. Fi ve of these
children made progress at a sl ower rate than would be expect ed, havi ng Proport i onal Change
Indi ces of less than one. The average gain made by the ot her 19 children was 15.5 mont hs,
wi t h an aver age Proportional Change Index of 2.35. However , for the total group of 24 children
assessed on the PPVT, a t-test compari son bet ween initial and final scores was not significant.
Screening Tests (DEST and DAST)
At intake 22 (91. 6%) children were unabl e to compl et e these tests because of behavi ors,
such as noncompl i ance, short attention span, distractibility, and anxiety that interfered with
their per f or mance. By the end of 12 mont hs these behavi ors had i mpr oved sufficiently to
enabl e all of the children to compl et e these tests.
Home Placement
At entry to the program, 14 children were living with their natural families, four were with
relatives, and six were in fost er families. Some of the children experi enced ongoi ng abuse that
necessi t at ed change of pl acement while attending the preschool. On leaving the program, 16
children were with their natural fami l y (all with onl y their mother), one was with relatives,
t wo were in fost er care, and five were in fost er/ adopt homes.
School Placement
At the t i me of di scharge from the KEEPSAFE Project, a multidisciplinary t eam, which
included represent at i ves f r om the Child Find Team of the Denver Public Schools, staffed eight
(33. 3%) of the 24 children into a regul ar cl assroom, 11 (45. 8%) required special educational
servi ces in the publ i c school system, three (12. 5%) went to residential care, and t wo were too
young for public education.
There seemed to be a relationship bet ween the chi l d' s home situation and school pl acement ,
with those children in stable homes, where abuse had ceased bei ng more likely to be pl aced
in a regul ar cl assroom. Of the seven children in stable homes who were old enough to be
placed, four were pl aced in a regular class, t wo went to special educat i on and one to residential
care. Thi s is in contrast to the five children living in an ongoi ng abusi ve situation where t wo
went to a regul ar class, t wo to special educat i on and one to residential care. There was a similar
di fference bet ween children in transitional care ( movi ng bet ween natural homes, fost eri ng and
adopt i on) and those in stable homes. Of the 10 children in transitional care old enough to be
placed, t wo went to regul ar school, seven to special educat i on and one to residential care.
However , the numbers in these groups were too small for a statistical compari son.
DI SCUSSI ON
These findings of developmental gains in abused children attending a therapeutic preschool are
consistent with other studies. Parish, Myers, Brandner, and Templin (1985), Culpe, Richardson,
and Heide (1987), and Culpe, Heide, and Richardson (1987) all showed that the children they
studied made developmental gains while Culp, Little, Letts, and Lawrence (1991 ) also demonstrated
1384 R.K. Oates, J. Gray, L. Schweitzer, R. S. Kempe, and R. J. Harmon
an enhancement in the children' s self-concept. An improvement in social behaviors among children
in a therapeutic preschool was shown by Fantuzzo, Jurecic, Stovall, Hightower, Goins, and Schach-
tel (1988).
The children in this project came from a variety of abusive situations. In some cases the abuse
was on-going. While the KEEPSAFE Project had control over the school curriculum and its
psychoeducational approach, the home environment was a variable over which the project had
much less control. It is likely that the twice-monthly home visits provided for these families were
not enough to make a major impact on families where there is considerable disturbance, particularly
where there is ongoing abuse. Even though home visitation has been shown to enhance certain
aspects of parental care-giving (Olds & Kitzman, 1993) it has not yet demonstrated that the
incidence of child abuse is reduced (Olds, Henderson, & Kitzman, 1994).
The children in this study were very disturbed at intake, with the assessment of the KEEPSAFE
team that none of them would be suitable to enter the public education system without intervention
and treatment. This view was reinforced by the difficulty over 90% of the children had in fully
cooperating with the visual and auditory screening tests at intake.
The majority of the children made developmental gains at a faster rate than would be expected,
particularly on the McCarthy Scales of Children' s Abilities. The language gains on the Peabody
Picture Vocabulary Test were not as marked suggesting that the language impairment seen in
many abused children, and which persists in many cases long after the abuse has ceased (Oates &
Peacock, 1984) may require an even more intensive approach with specific language therapy for
these children. However, it is difficulty to explain why the three children who made less than 12
months gain on the McCarthy Scales all made gains on the Peabody Picture Vocabulary Test with
a Proportional Change Index of 1.8 or greater. Similarly, four of the five children who made little
progress in their language development showed quite marked gains on the McCarthy Scales.
Overall the change for most children was consistent, showing catch-up development in most areas
tested.
The KEEPSAFE Program provided 12 months of academic and therapeutic intervention to 24
children originally judged to be inappropriate for public school placement because of developmental
delays and abnormal behaviors. At discharge from the Program a multidisciplinary team staffed
over 79% into public school -33. 3% into a regular classroom and 45.8% into special education
within the public education system. Only 12.5% required residential care by the time of discharge.
Two children were too young for public school.
A therapeutic preschool for abused children is expensive in terms of the need for a high ratio
of professional staff to children and also expensive in teams of the emotional impact this work
can have on the professionals working with these children and families. In addition to the individual
child and family contact, time is needed for team meetings, case coordination and multidisciplinary
reviews of each child' s progress.
It is clearly an essential part of any program for abused children that there be at least three
areas where work needs to be done; help for the child in feeling safe, secure, confident, and valued;
help for the parents in coping with the stresses of child-rearing and in having realistic expectations
for their children; and help for the parents and children as a unit in working on their relationship.
For those who are considering developing a similar curriculum for abused preschool children,
it is important for the curriculum to be flexible enough to take into account the varying ages of
the children and their range of different problems. Considerations when designing a schedule
should also include the children' s tolerance and attention skills, and the type of work which needs
to be done with each child' s family or caretaker.
CONCLUSI ON
The KEEPSAFE Preschool Program showed that disturbed, abused children can be hel ped
in a secure, structured, therapeutic envi ronment so that many were able to make marked
Therapeutic p r e s c h o o l 1385
i mprovement in their de ve l opme nt and behavi or. By the ti me o f di scharge from t he Program
many were able to enter the publ i c educat i on s ys t em, an achi evement l i kel y to result in major
fi nanci al and emot i onal s avi ngs compared wi t h t he al ternati ve o f i nst i t ut i onal i zat i on.
Howe ve r , it woul d be a mi stake to as s ume that our responsi bi l i t y t o t hese chi l dren c l os e s
o nc e t hey l eave the therapeuti c pres chool program. A 7- year f o l l o w- up o f chi l dren wh o had
been treated in a psychi atri c day treatment cent er ( Sack, Mas on, & Col l i ns , 1987) f ound that
many remai ned s ympt omat i c on revi ew, whi l e a 4- ye ar f o l l o w- up o f chi l dren wh o had attended
therapeuti c day care ( Houc k & Ki ng, 1993) s ho we d that there were persi sti ng probl ems i n
aggres s i on, anxi et y, and adapti ve abi l i ti es. A therapeuti c pres chool gi ve s abused chi l dren a
g o o d start, but many wi l l need c ont i nui ng treatment.
Acknowledgement~Credit for much of the work in the KEEPSAFE Project and for input to this paper is due to JoAnn
Blum, Shei l a Gray, and Sari Johan.
REFERENCES
Bredekamp, S. (1987). Developmentally appropriate practice in early childhood programs serving children f rom birth
through age three. Washi ngt on DC: National Associ at i on for the Education of Young Children.
Briggs, D. C. (1975). Your child' s sel f esteem. New York: Doubl eday.
Culp, R. E., Heide, J. S., & Richardson, M. T. (1987). Maltreated chi l dr en' s devel opment al scores. Treat ment versus
non treatment. Child Abuse & Neglect, 11, 29- 34.
Culp, R. E., Richardson, M. T., & Heide, J. S. (1987). Differential devel opment al progress of maltreated chi l dren in
day treatment. Social Work, 32, 497- 499.
Culp, R. E., Little, V., Letts, D., & Lawrence, H. ( 1991 ). Mal t reat ed chi l dr en' s sel f-concept : Effect s of a compr ehensi ve
t reat ment program. American Journal of Orthopsychiato,, 61, 114-121.
Dunn, L. M., & Dunn, L. M. (1981). Peabody Picture Vocabula O, Test-Revised. Circle Pines, MN: Ameri can Gui dance
Service.
Egeland, B., Sroufe, L. A., & Erickson, M. (1984). The devel opment al consequences of di fferent patterns of mal-
treatment. Child Abuse & Neglect, 7, 459- 469.
Fant uzzo, J. W., Jurecic, L., Stovall, A., Hi ght ower, A. D., Goins, C., & Schachtel, D. (1988). Effect s of adult and
peer social initiations on the social behavi or of wi t hdrawn, maltreated preschool children. Journal of Consulting
and Clinical Psychology, 56, 34- 39.
Houck, G. M., & King, M. C. (1993). Cogni t i ve functioning and behavioral and emot i onal adj ust ment in maltreated
chi l dren post-interventional. Journal of Child and Adolescent Psychiatr), Mental Health Nursing, 6, 5- 17.
Kline, D. F. (1977). Educational and psychol ogi cal probl ems of abused children. Child Abuse & Neglect, 1, 310-
317.
Martin, H. P., Beezley, P., Conway, E. F., & Kempe, C. H. (1974). The devel opment of abused children. Advances
in Pediatrics, 21, 25- 73.
McCart hy, D. (1972). McCarthy Scales of Children's Abilities. New York: Psychol ogi cal Corporation.
McCormack, A., Janus, M. D., & Burgess, A. W. (1986). Runaway youths and sexual victimization. Child Abuse &
Neglect, 10, 378- 395.
Northern, J. (1981). Audi ol ogi c evaluation. In W. K. Frankenburg, S. M. Thornt on, & M. E. Cohrs (Eds.), Pediatric
developmental diagnosis (pp. 67- 77) . New York: Thieme-Stratton.
Oates, R. K. (1984). Personality devel opment aft er physical abuse. Archives of Disease in Childhood. 59, 147- 150.
Oates, R. K., & Peacock, A. (1984). The devel opment of abused children. Developmental Medicine and Child
Neurology, 26, 694- 656.
Olds, D. L., & Kitzman, H. (1993). Revi ew of research on home visiting for pregnant women and parents of young
children. The Future of Children, 3, 123-165.
Olds, D. L., Henderson, C. R., & Kitzman, H. (1994). Does prenatal and infancy home nurse visitation have enduri ng
effect s on qualities of prenatal care giving and child health at 25 to 50 mont hs of life. Pediatrics, 93, 89- 98.
Parish, R. A. , Myers, P. A., Brandner, A., & Templ i n, K. H. (1985). Devel opment al mi l est ones in abused chi l dren
and their i mprovement with a fami l y-ori ent ed approach to the treatment of child abuse. Child Abuse & Neglect, 9,
245 - 250.
Sack, W. H., Mason, R., & Collins, R. (1987). A l ong-t erm fol l ow-up study of a chi l dr en' s psychiatric day t reat ment
center. Child Psychiato' and Human Development, 18, 58- 68.
Sprague, J. (1981). Opht hal mol ogi cal evaluation. In W. K. Frankenburg, S. M. Thornt on, & M. E. Cohrs (Eds.),
Pediatric developmental diagnosis (pp. 57- 65) . New York: Thieme-Stratton.
Steele, B. (1982). Di scovery of chi l dren at risk for j uveni l e delinquency. In F. N. Dutile, C. H. Foust, & D. R. Webst er
(Eds.), Earl), childhood intervention and juvenile delinquency (pp. 93- 101) . Lexi ngt on, MA: Lexi ngt on Books.
Tong, L., Oates, R. K., & McDowel l , M. (1988). Personality devel opment fol l owi ng sexual abuse. Child Abuse &
Neglect, 11, 371- 383.
1386 R . K. Oat es, J. Gray. L. Schwei t zer, R. S. Kempe, and R. J. Har mon
Wol er y, M. (1983). Proport i onal Change Index. An al t ernat i ve for compar i ng chi l d change data. Exceptional Children,
50, 167- 170.
R6sum6----Vi ngt -quat re enf ant s ont assi st 6, ent re 1985 et 1988, h une 6cole mat ernel l e t h6rapeut i que pour enf ant s
ayant subi des s6vi ces phys i ques et sexuel s. L' 6col e offrai t un pr ogr amme d' 6ducat i on pour j e une s enf ant s et une
th6rapie afin de permet t re aux enf ant s vi ct i mes d' am61i orer l eur d6vel oppement et l eur bien-fitre social et af f ect i f pour
ensui t e l es pr6parer h s' i nt 6gr er au syst 6me scolaire. Cet t e 6cole thErapeutique 6tait j umel l 6e h u n pr ogr a mme de vi si t e
domi ci l e vi sant l es par ent s ou gar di ens de l ' enf ant afin d' am61i orer l ' i nt eract i on ent re I' adul t e et I ' enf ant . La pl upart
des enf ant s ont fait des progrbs pl us rapi des qu' us ue l , sel on les t est s McCar t hy Scores of Chi l dr en' s Abi l i t i es et le
Peabody Pi ct ure Vocabul ar y Test . Bi en q u ' o n dout ai t au d6part que ces 24 enf ant s pui ssent 6vent uel l ement s ' i nt 6gr er
au syst bme scolaire, on a not6 qu' apr bs 12 moi s de part i ci pat i on au pr ogr amme, pl us de 79 p.c. ont fai t l eur ent r6e
a l ' 6 c o l e - - s o i t 8 enf ant s (33.3 p.c.) dans une cl asse r6guli6re et 1 I (12,5 p.c.) dans un pr ogr amme de soi ns r6si dent i el s.
Deux des enf ant s 6taient trop j e une s pour aller ~ l ' 6col e. M6me si ce genr e de pr ogr amme est di spendi eux, 6t ant
donn6 le petit nombr e d' e nf a nt s par ensei gnant , l es r6sultat sont b6n6fiques.
Re s u me n - - Ve i n t i c u a t r o nifioslas asi st i eron a un pr e- escol ar terapEutico para nifios/as abus ados fi si ca y sexual ment e:
el Proyect o Ke mpe de Educaci 6n Te mpr a na At endi endo Fami l i as Abus adas ( Kempe Earl y Educat i on Proj ect Ser vi ng
Abus ed Fami l i es - KEEPSAKE) por un peri odo de t res afios desde el 1985 al 1988. El pr ogr ama le of r eci 6 educaci 6n
t empr ana y t erapi a a nifios/as abus ados par a que rnej oraran su desarrol l o a s / c o mo social y emoci onal ment e; con el
obj et i vo de que l os nifios/as est uvi er an apt os para ent r ar en el s i s t ema educat i vo ptiblico. La educaci 6n pr e- escol ar
t erap6ut i ca se combi n6 con un pr ogr ama de vi si t a al hogar dedi cado a l os padres del nifio/a o ~il r esponsabl e pr i mar i o
de su cui dado, enf ocando mej or ar la cal i dad de la i nt eracci 6n ent re el adul t o y el nifio/a. La mayor / a de l os ni fi os/ as
obt uvi er on gananci as evol ut i vas en me nos t i empo que l as expect at i vas nor mal es de acuer do a la Escal a de McCar t hy
de Habi l i dades l nf ant i l es y la Pr ueba Peabody de Fi gur as y Vocabul ari o (Peabody Pi ct ure Vocabul ar y Test ). A pes ar
de que, al inicio de la i nt ervenci 6n, se pens6 que l os 24 nifios/as no podri an part i ci par en el cont ext o de la es cuel a
publ i ca; despu6s de 12 mes es en el pr ogr ama m~is del 79% i nscri t os en el s i s t ema educat i vo publ i co; t res ot r os
necesi t aron cur sos en resi denci a y dos er an demas i ado pequefi os para ent rar en la escuel a ptlblica. A pesar de que un
pr e- escol ar t erap6ut i co resul t a cost oso por el alto nt l mero del presonal que necesi t a por cada nifio/a, es mu y probabl e
que benefi ci e el desarrol l o de l as habi l i dades i nfant i l es.