Help for the Helpless : For abused children, Stuart House offers comprehensive care and a guiding hand through a ‘nightmare’ system.

The room looks so cute that it takes a moment for reality to sink in. Coloring books sit on the little table, the panels of the folding screen turn into a turreted playhouse, pastels brighten cupboard handles and doorknobs, a playful plush monkey clings to a stethoscope.

But then there is the tiny examining table--with cold metal stirrups at one end.

This is no playroom.

The clinic is part of a program for young victims of sexual assault, run by Santa Monica Hospital’s Rape Treatment Center. The rest of the program is down the street at a separate facility, Stuart House--a toy-filled, stuffed-animal pastel haven. All the fanciful touches are just part of the effort to minimize additional trauma to the children.

The center opened Stuart House in 1988 because “the system children had to go through was a nightmare. They were constantly revictimized,” says Gail Abarbanel, the center’s founder and director.

The “system,” in fact, involved three very different, and poorly coordinated, aspects--criminal justice, child welfare and medical care. And what had been intended to provide comfort, healing and justice for the victim often amounted to punishment:

* Examinations in threatening emergency rooms, often by medical people untrained for this particularly sensitive task; evidence undetected or lost. One horror story involved a 4-year-old girl subjected to three pelvic exams at three hospitals.

* Interviews in noisy, crowded police stations and district attorney’s offices.

* Repeated interviews, as many as 12 to 20 per victim, and a confusing maze of law enforcement, protective service and social work officials. Case workers frequently replaced each other, providing no continuity.

* Trips to dependency court, precipitous removal from home and family, placement in a strange home or institution. The alleged abuser often remained in the home while the child was removed.

* A frightening, bewildering time on the witness stand in a roomful of strangers.

In contrast, Stuart House has developed a comprehensive, friendly approach to treatment, legal action and therapy. The various parts of the system come to the child in a non-institutional environment, and this system tries to accommodate itself to the victims’ needs. Police, prosecutors, therapists and social workers work with the young victims in friendly environs.

Stuart House has what Abarbanel calls a simple philosophy and treatment guideline: “What’s best for the child?”

And what’s best, professionals say, often results in better evidence and swifter justice.

Nancy Daly, a member of the Los Angeles County Children’s Services Commission and the National Commission for Children, says Stuart House’s one-roof, multidisciplinary approach “is the only approach. It saves children tremendous grief and pain, and it should be going on all over the county, state and country.”

On the first visit, Aileen Adams, the center’s legal counsel and child advocate, or Stuart House Director Colleen Friend meets everyone, provides a detailed tour and tells the child and family what to expect. They explain everything, even the one-way mirror in the interview room: Someone will be looking on, they say, usually the social worker from Children’s Services.

“We do not keep any secrets from them,” Abarbanel says.

The young victims have had enough secrets.

Call her Marlene. For reasons of confidentiality her family’s real names cannot be used.

She is 29, and the mother of Debbie, 7, and Patty, 5. She sits at a child-sized table in a sound-proofed, soft-colored interview room at Stuart House. Last summer, Debbie sat a similar table and told her story to the police and district attorney. Today, Marlene retells the story, still showing shock and disbelief. The case is going through the court system; a trial is imminent.

Marlene says a family friend molested Debbie. He was divorced, said he loved kids and volunteered in community activities. He enjoyed taking kids on outings--to the zoo, picnics, McDonald’s, movies. Sometimes there would be overnights at his house.

Patty, who tends to cling to her mother, never wanted to go. Just Debbie.

One morning Debbie returned from a movie and overnight outing with an expensive Barbie doll set. The doll aroused Marlene’s suspicions because the family friend was not wealthy; also, Debbie seemed “real down and out, and she was getting smarty with me.”

Finally, while in the bathroom with Debbie, Marlene learned there had been no Ninja Turtles movie the night before. She learned that sometimes there were no other kids on the excursions.

She asked questions. “If I tell you,” Debbie replied, “you’ll punish me and he’ll punish me.”

What followed, with plenty of reassurances from Marlene, was a vague, incomplete story of touching, of taking pictures, of threats to kill Debbie and her family. It was clear from the telling that the molestation had happened before; Marlene still doesn’t know how many times Debbie had been abused.

“When she told me he licked her privates, I walked out of the bathroom and I almost fell apart: ‘Oh my God. What’ll I do?’ I freaked out. I didn’t want her to see,” Marlene recalls. “I called her godmother and she said, ‘We’ve got to get her to a doctor.’ ”

They took Debbie, and a bag with the clothes she had worn, to Santa Monica Hospital. A police officer arrived at the emergency room and told Marlene they would be going to Stuart House.

And that he didn’t want Debbie to be scared.

Stuart House serves the west judicial district of Los Angeles County Superior Court. It houses professional staff from the county Department of Children’s Services, district attorney’s office and the Los Angeles Police Department. On some cases, it works closely with the county Sheriff’s Department and the Culver City, Santa Monica and Beverly Hills police departments.

Besides government workers, Stuart House’s own professional staff of six provides coordination and therapeutic counseling for children and family members.

All services are free. The program is a private-public partnership. The building, operating funds and services are provided by the hospital, several charitable foundations, corporations and individual donors. Government agencies pay for their own personnel and services. Annual operating costs are $500,000, excluding salaries for government employees.

The Rape Treatment Center did not see many children until the McMartin case of alleged child sexual abuse shocked the nation in 1984. After that, and several television shows on the subject, Abarbanel says, reports and requests for treatment rose at the center and nationwide.

According to Stuart House surveys and reports, the National Institute of Justice estimates that one of every four girls and one of every eight boys has been sexually abused before age 18.

Nationally, more than 90% of those reported cases are not prosecuted, usually because of lack of evidence or the unwillingness of victims’ families to participate. Psychotherapy and counseling generally are not available, nor is there much pressure on families who deny the seriousness of the abuse to obtain treatment for their children.

Although there are other multidisciplinary programs in the country, Stuart House claims to be the most comprehensive in the nation. Since it opened, it has handled nearly 1,000 cases, and at least 25% of those have led to criminal prosecutions.

“We wanted to do something to change the system and come up with a better program for children,” Abarbanel says. “There are two issues--justice and healing. That’s what Stuart House is about.”

Gregory Thompson, chief deputy district attorney for Los Angeles County, calls Stuart House an unequivocal success in its treatment of victims.

“Stuart House is important because it’s the first and most comprehensive treatment center,” he says. “No place else has that in California.”

He says that in terms of arrests and prosecutions, “Stuart House is essentially the same as we get in other places in the county. Stationing deputy district attorneys at the house is slightly less cost-efficient, he says, but “this is far outweighed by other benefits.

“If we tried to do it countywide, space and facilities would be a serious problem. It was overcome (at Stuart House) by generous people.”

Daly praises Stuart House’s “vertical case management,” in which one social worker or lawyer handles a case from start to finish. That has not been the general practice at the Department of Children’s Services, she says, but the county Children’s Services Commission has recommended since its inception seven years ago that vertical caseloads become departmental policy.

Debbie’s case illustrates the difference at Stuart House.

At her first visit, she was interviewed by a Los Angeles police detective assigned to the program and by William Penzin, one of two deputy district attorneys who work at Stuart House. That’s standard procedure here, but not for the rest of the system. Usually, without such close coordination, the district attorney’s office is not involved until much later.

Debbie hinted that pictures had been taken and, Penzin says, later revealed where they were kept.

“The detective and the D.A. could consult right away, and we got a search warrant,” Penzin says. Next morning, police went to the suspect’s house.

They found pornographic photos involving Debbie.

“It happened so fast, before he could destroy the evidence,” says Detective David Berglund, who was at the man’s house. “He’s denied it, but it’s strong evidence.” The suspect is in jail, awaiting trial.

And while the case has moved through the legal system, Debbie and her mother have been in treatment.

It is a long road for both.

The suspect had told Debbie that he’d kill her family and take her away if she told. And when Marlene and Debbie returned from the initial interview, there was a message from him on their answering machine about yet another outing: “I’m coming over to pick up (Debbie).”

Terrorized, Debbie cried, “Mommy, he’s coming to get me.”

The terror has not entirely gone away. Nor have the nightmares.

“She shook me awake at 3 a.m. one night, crying, ‘Are you alive? You’re alive, right?’ She’d had a bad dream that he’d gotten out of jail and was on his way over,” Marlene says of Debbie. “She tells me to get bars on all the windows and doors and that she wants to move to Arizona. She’d feel safe near her grandmother.”

Debbie told the officer and district attorney that she wanted to be re-examined, to make sure her body was all right. And it was all right, Marlene says, adding, “She felt real good about that.”

The Stuart House mothers’ therapy group seems to have helped Marlene most. Sometimes she’s so dispirited that she cannot distract herself.

“Why did I trust him? Why, why? She’s a helpless child. How come I didn’t sense it?” she asks. “I think if it were not for this place, a lot of parents would go crazy.”

And she is prepared, when Debbie becomes moody, to accept that she cannot always help. The little girl has developed a deep, trusting relationship with her therapist, one that is separate from her relationship with her mother.

“Sometimes when she gets moody and smart, I’ll say, ‘You can’t get so grouchy at me. If you don’t want to talk to me, call your therapist.’ And she will. I’ll leave the room and let her talk privately,” Marlene says.

No matter who talks about the work at Stuart House, the same words crop up: trust, support, respect, healing. People here talk about respecting the child’s privacy, dignity and self, about earning a child’s trust. They see themselves helping to create an environment in which healing can begin--a process, they acknowledge, that in some respects will last a lifetime.

It starts with volunteers who get down on the waiting-room floor, playing and visiting with the children. Friend, the program director and a clinical social worker, says the volunteers are trained to be role models for “an appropriate adult relationship that is not intrusive or controlling. . . . We do not encourage them to touch the kids. We don’t know what touching means to them. They could have difficulty trusting adults.”

The children set their own pace, says Cheryl Lanktree, the psychologist who heads the therapeutic services. “They’ve been abused and traumatized by adults. We don’t expect them to trust us. It’s so important for them not to feel pressured.”

The treatment, which starts immediately, lasts as long as necessary--regardless of what happens with the legal case.

Under the usual system, if a case is not filed, says Penzin, “you refer them to therapy, give them a number and never follow up. You never see them again, and you wonder what happened to that kid.”

And there are other benefits of the Stuart House approach.

“If the molestation has taken place in the home, in the family, we’d prefer to have the perpetrator leave,” says Ann Ach, the department of Children’s Services supervisor who oversees the two social workers--one of whom speaks Spanish--assigned to the house.

She says, however, that her agency can only remove the child and that early coordination with the police can result in removing the alleged abuser. Very few Stuart House cases--three in the last year--have resulted in removals of the child, she says.

“This gives a clear message to the child about who the person in the wrong is,” says Ach.

It seems that such messages--and the support, strength, even empowerment that their work gives the child--draw people to this work and enable them to stay with it.

Victoria Adams, a deputy district attorney with the program, has a 1 1/2-year-old daughter. She says she discussed the Stuart House assignment with her husband before she requested it. It was a tough decision, Adams says, but she knows her own daughter soon will have to face the world, and it makes her more determined than ever that the system not victimize the victims. The work is rewarding, she says, but the cases can be depressing:

“It’s hard for people who don’t do this type of work to believe what people do to children.”

And sometimes hard for people who do do this work.

Pediatrician Sabina Sonneman performs the physical examinations in the little clinic but works independently from the Stuart House team. Since 1985, she has conducted several thousand of these exams in her practice. Still, she can be shocked.

“Oh, yes. Yes, yes,” she says solemnly, briefly closing her eyes.

Sonneman’s comments and feelings seem to mirror those of most of the program’s staff.

“People often ask me why I do this work, why I like it,” she says. “I don’t particularly like doing examinations of this nature. But I feel an absolute need for these children to be helped with these difficult situations.”

Soon, Aileen Adams, the center’s legal counsel, will prepare Debbie for court. As the trial date nears, Debbie will learn what to expect.

She will visit the courthouse, meet the judge and the bailiff, sit in the witness chair, have a look around. She is looking forward to it, her mother says, just as she looks forward to her trips to therapy. She even reminds Marlene when it is time for the mothers’ therapy group. That way she gets to make an extra visit herself and play with the volunteer in the front room.

“It’s time. Let’s get going,” she tells her mom.

Marlene says Debbie trusts the people at Stuart House:

“She’ll have me drive by here during the week. She goes for swimming lessons up the street, and she’ll tell me, ‘I just want to make sure they’re still here and the people in there are OK.’ She has me drive in front of it and then up the alley behind it. Then she’ll say, ‘OK. It’s still there. Let’s go home.’ ”