Child maltreatment rates assessed in a national household survey of caregivers and youth

This paper reports on national estimates for past year child maltreatment from a national household survey conducted in 2011. It also discusses the validity of such estimates in light of other available epidemiology. The Second National Survey of Children Exposed to Violence obtained rates based on 4,503 children and youth from interviews with caregivers about the children ages 0–9 and with the youth themselves for ages 10–17. The past year rates for physical abuse by caregivers were 4.0% for all sample children, emotional abuse by caregivers 5.6%, sexual abuse by caregivers 0.1%, sexual abuse by caregivers and non-caregivers 2.2%, neglect 4.7% and custodial interference 1.2%. Overall, 12.1% of the sample experienced at least one of these forms of maltreatment. Twenty-three percent of the maltreated children or 2.8% of the full sample experienced 2 or more forms of maltreatment. Some authority (teacher, police, medical personnel or counselor) was aware of considerable portions of most maltreatment, which suggests the potential for intervention. Many of the study's estimates were reasonable in light of other child maltreatment epidemiological studies, but comparisons about emotional abuse and neglect were problematic because of ambiguity about definitions.     

Experiences of fatherhood among men who were sexually abused in childhood

BackgroundFatherhood is a complex psychological process, which is shaped at a profound level by reflections on past childhood memories and parenting experienced in childhood. Fathers who were sexually abused in childhood may experience particular challenges for their fathering identity and parenting role.ObjectiveThis qualitative study explored the experiences of fatherhood for men who were sexually abused in childhood and how they perceived themselves in the fathering role.Participants and SettingEleven participants were recruited to the study from three therapy services for adult survivors of abuse in the Republic of Ireland.MethodsData collection comprised face to face semi-structured interviews, which were audio recorded and subsequently transcribed verbatim. Data analysis drew on Interpretative Phenomenological Analysis and two superordinate themes with associated subthemes were identified.ResultsParticipants’ experience of childhood sexual abuse provided a lens through which they experienced fatherhood and themselves in a fathering role. Fatherhood influenced participants to confront unintegrated aspects of the trauma they experienced in childhood, which manifested in hypervigilance with regard to their children’s safety and doubt that they were good enough fathers. However, fatherhood also offered an opportunity to heal. This occurred through striving to provide a better father-child relationship and through connection in restorative relationships, including the therapeutic relationship.ConclusionFatherhood was seen as a potential resource for positive change and can influence long held internal working models of the self and others.     

Characteristics of child physical and sexual abuse as predictors of psychopathology

Childhood physical and sexual abuse victims are at increased risk for developing depression, anxiety, and post-traumatic stress disorder (PTSD) in adulthood. Prior findings suggest abuse onset, duration, and severity moderate relationships between victimization and psychopathology. However, because these abuse characteristics are highly intercorrelated, their unique, individual effects on mental health outcomes remain unclear. To address this gap, the present study examined relationships between physical and sexual abuse characteristics and mental health outcomes and whether these relationships differed by sex. A diverse community sample of late adolescents and emerging adults (N = 1270; mean age = 19.68; 51% female) self-reported the onset, duration, and severity of physical and sexual abuse, as well as their depressive, anxiety, and PTSD symptoms. Results of a multivariate regression model (simultaneously evaluating all physical and sexual abuse characteristics) indicated that physical abuse onset in middle childhood and sexual abuse onset in middle childhood or adolescence were associated with all forms of psychopathology; and physical abuse onset at any time was uniquely linked with PTSD. Duration and severity of physical or sexual abuse did not predict psychopathology after accounting for time of onset. Multigroup analyses indicated that adolescence-onset and duration of sexual abuse respectively predicted anxiety and PTSD in females but not males, whereas sexual abuse severity predicted fewer PTSD symptoms in males but not females. Overall, results suggested that abuse occurring after age 5 may have the most deleterious impact on mental health.     

The relationship between parental substance abuse and child maltreatment: findings from the Ontario Health Supplement

OBJECTIVE: This study examined the relationship between reported exposure to child abuse and a history of parental substance abuse (alcohol and drugs) in a community sample in Ontario, Canada. METHOD: The sample consisted of 8472 respondents to the Ontario Mental Health Supplement (OHSUP), a comprehensive population survey of mental health. The association of self-reported retrospective childhood physical and sexual abuse and parental histories of drug or alcohol abuse was examined. RESULTS: Rates of physical and sexual abuse were significantly higher, with a more than twofold increased risk among those reporting parental substance abuse histories. The rates were not significantly different between type or severity of abuse. Successively increasing rates of abuse were found for those respondents who reported that their fathers, mothers or both parents had substance abuse problems; this risk was significantly elevated for both parents compared to father only with substance abuse problem. CONCLUSIONS: Parental substance abuse is associated with a more than twofold increase in the risk of exposure to both childhood physical and sexual abuse. While the mechanism for this association remains unclear, agencies involved in child protection or in treatment of parents with substance abuse problems must be cognizant of this relationship and focus on the development of interventions to serve these families.     

Women's voices on recovery: a multi-method study of the complexity of recovery from child sexual abuse

OBJECTIVE: The current study was exploratory and used multiple methods to examine patterns of stability and change in resilient functioning across 7 years of early adulthood. Second, qualitative data were used to examine in greater detail survivors' own narratives about correlates of healing. METHOD: This study was longitudinal and used both structured and open-ended interviews. Eighty women with documented hospital records of child sexual abuse were interviewed at two time points 7 years apart in early adulthood. Structured interviews including investigator-based questions and standardized measures of trauma exposure and functioning were conducted. A subset of 21 survivors participated in in-depth, open-ended interviews about coping with sexual abuse. RESULTS: Quantitative findings showed patterns of both stability and change on an index of resilient functioning across multiple domains in the 7 years between interviews with 76% of participants showing less than a one standard deviation change in scores. Lower resilience was associated with exposure to additional trauma between the two interviews (r=-.44) while positive functioning was related to social role satisfaction and positive sense of community. Qualitative data permitted examination of the dynamic quality of recovery over time including the role of "turning points" across the lifespan. CONCLUSIONS: The findings extend previous studies of resilience in the examination of how it changes over the course of one segment of the life cycle. This study supports recent work that described resilience as a non-linear process and further highlights factors including the role of re-traumatization, social supports, and opportunities for making new choices that may be important correlates of recovery processes among sexual abuse survivors over time.     

The school: Liberator or censurer?

The community is faced with an increasing number of children suffering from social and emotional difficulties. As all children attend school, this is a highly suitable place to examine possible means of identifying and helping children suffering from social and emotional difficulties. For the last 20 years most schools have lagged in their adjustment to the full range of needs of students. They act as a censurer by: domination of academic requirements causing many to fail; failure to meet the expressed needs of children; inadequate teacher training; too little help given to children and often too late; uncoordinated assistance within the school or with community agencies; and by not reducing peer abuse. The school can play a significant role in child development, but for the child with adjustment difficulties coherent assistance is rarely offered. The school can liberate by: recognition of the needs of non-academic children; recognition of the affective needs of all; providing affective training for selected teachers; giving appropriate curriculum time for a programme in personal growth and social relationships; by developing a multidisciplinary community agency which interacts with the school. A model is proposed outlining how effective intervention will break and prevent the cycle of abusive behaviour. This programme proceeds sequentially through each grade. Basically it is one of effective student group interaction in the presence of a specially selected and trained group leader. Such a programme contributes to change in school philosophy, and increases the possibility of the child becoming a more adequate adult/parent. Negative emotional effects of bureaucracy and the Australian school institution on children are discussed. This paper looks critically at schools, outlines some ways in which such abuse is manifested and discusses how the schools can become factors in healing as well as preventing abuse.     

Violence among family members of children and adolescents evaluated for sexual abuse

OBJECTIVES: The two aims of this study were to: (1). describe the prevalence and characteristics of domestic adult and child physical violence in the homes of children and adolescents evaluated in a specialized sexual abuse clinic and (2). describe parent or caretaker responses to domestic adult and child violence and child sexual abuse, including tendencies to report or seek medical care. METHOD: A consecutive sample of 164 subjects (ages 7-19) were interviewed in a sexual abuse clinic regarding in-home violent or abusive experiences among family members that had occurred at any time during their childhood. RESULTS: Fifty-two percent of these children and teenagers reported spousal violence in their home. Fifty-eight percent of child sexual offenders who were in-home males also physically abused their adult female partner. Half of in-home males who were physically violent to children also sexually abused them. In 86% of homes with partner violence, the children were also physically assaulted. There was no difference in sexual abuse disclosure rates or patterns for children living with or without adult violence. CONCLUSIONS: Sexually abused children should be questioned about physical abuse and the presence of violence among adults in their home. Safety plans for sexually abused children should incorporate screening for family violence and safety plans for parents and siblings of child victims, when appropriate.     

EVALUATION OF A MEDICINE INFORMATION TRAINING PROGRAM FOR OLDER PEOPLE

This article describes a medicine information training project initiated through concerns of older people in Australia about the inappropriate use of medicines and adverse consequences on their health. The training program uses experiential and adult learning strategies to train older people to act as advocates and peer role models to inform their peers on the wise use of medicines. The process evaluation conducted established the high quality of the training program's content, staff, documentation, and other resources. However, feedback from graduates indicated the difficulties experienced by older learners when the training is too concentrated. The wide reach of the program, as assessed through the extensive recorded activities of the program's graduates in the community, was positive. The immediate impact evaluation on those completing initial training identified an increase in self‐reported self‐esteem, whereas the intermediate evaluation on experienced graduates showed that growth in personal development had been sustained several years post‐graduation. None regretted volunteering to be trained and all reported deriving great satisfaction from assisting their peers. They would recommend the training to others, but only if they are willing to listen and invest the time needed during and after training. Relatively high rates of attrition due to death, ill‐health, and family commitments were recorded and implications noted. This project successfully mounted a community‐based program to train older people to act as peer educators, with noticeable benefits to program participants. The procedures used, and the insights obtained through participants’ feedback, have relevance for planning other training programs for older learners.     

Predicting the child-rearing practices of mothers sexually abused in childhood.

OBJECTIVE: Although empirical investigations have established a relationship between childhood sexual abuse and numerous long-term consequences, surprisingly little research has addressed the possible effects of childhood victimization on the later child-rearing practices of adult survivors. The present study examined hypothesized predictors of three parenting styles among adult survivors of sexual abuse as compared with adult children of alcoholic parents. METHOD: Forty-five clinical outpatients completed a questionnaire battery assessing experiences of childhood abuse, current economic and social resources, and parenting attitudes and practices. The child-rearing practices of participants were compared with those reported by a community sample of 717 mothers. Additional analyses examined the extent to which sexual abuse and its adult sequelae predicted the parenting behaviors reported by the present sample. RESULTS: Both sexual abuse survivors and children of alcoholics reported significantly higher rates of permissive parenting practices than mothers in the community sample. Multiple regression analyses further revealed unique relationships between sexual abuse and parenting, over and above the variance explained by physical abuse, current socioeconomic status, and the experience of growing up in an alcoholic home. Mothers' sexual abuse severity, social support satisfaction, and dysfunctional parenting attitudes moderated several of these relationships. CONCLUSIONS: The present findings suggest that sexual abuse and its adult sequelae may have negative consequences for the parenting practices of survivors, particularly for survivors' ability to provide their children with appropriate structure, consistent discipline, and clear behavioral expectations. Implications for the psychosocial development of survivors' children are discussed.     

Strategies for Increasing Faculty Involvement in Institutional or Program Assessment

This narrative research study was conducted to explore the experiences of full-time community college faculty members involved in student learning outcomes assessment. Prior research documented the need for more community college faculty involvement with assessment at the program and institutional levels (Grunwald & Peterson, 2003; Kinzie, 2010; Nunley, Bers, & Manning, 2011); however, little research had been published about faculty experiences with assessment at these levels. This study adds to the body of literature about community college faculty participation with assessment by sharing the perspectives of faculty members who had participated with either program or institutional assessment on their campus. One-hour semi-structured interviews with nine participants at three different 2-year institutions recognized for their assessment processes provided the data for the study. The size of this study was limited to nine participants so that an in-depth exploration of each participant’s experience with assessment could be conducted. The shared experiences of the participants in this study revealed that faculty involvement with assessment beyond the course level was primarily influenced by faculty perception of assessment being valued as a tool for institutional improvement. Three indicators of the value placed on assessment by these institutions were that they: (a) allocated resources (time and training) for assessment, (b) clearly articulated the goals of assessment at their institution, and (c) demonstrated how assessment results were used in institutional decision-making. This study also revealed that faculty members’ prior experience working with assessment and individual skills or abilities also influenced decisions to become involved with assessment.     

On personal and collective dimensions of agency in doctoral training: medicine and natural science programs

The purpose of the present study was to investigate knowledge-creating agency by examining doctoral students' accounts of their pursuits, using structured interviews. We examined all of the talk apparently related to agency of 13 doctoral students taking part in collective doctoral training in two, highly regarded Finnish research communities (natural science and medicine). The doctoral process involved the participants pursuing article-based theses based on collectively shared research problems and journal articles co-authored with the supervisor and other senior researchers. Based on the qualitative analysis of the interviews, three categories of agentic talk were identified, respectively, for three proposed types of knowledge-creating agency: personal, distributed, and ‘object-related’. Personal agency involved participants' reflection on their academic competence, self-efficacy, and personal strengths and weaknesses. Distributed agency played an important role in assisting these participants overcoming challenges; this includes sharing of expertise, receiving social support, and having a sense of collective efficacy. Object-related agency, in turn, represented integration of a doctoral student's efforts with those of her immediate research community while pursuing shared research objects (e.g., co-authored articles). Apart from issues of agency which, the authors propose, are raised in the interviews, the data provide content-rich accounts of the collective nature of doctoral experiences.     

Examining the validity and reliability of childhood abuse scales: putting the courage to heal to the test

Objective: The main purpose of the current study was to examine the validity and reliability of The Courage To Heal Workbook checklist (Davis, 1990) in part, through examining the internal consistency and studying whether the CTHC distinguished between the participants reporting sexual abuse histories and those who did not.Method: Two hundred and seventy-nine college students were surveyed utilizing the symptom checklist from the Courage to Heal Workbook, Trauma Symptom Checklist-40 (TSC-40), Abusive Behavior Inventory (ABI), and questions related to participants’ beliefs that they had been abused as a child.Results: Results indicated that the Courage to Heal Checklist (CTHC) has robust reliability (alpha = .97) and can significantly discriminate between reported abuse survivors and nonsurvivors. Fifty-five percent of those participants reporting sexual abuse, 47% of those reporting physical abuse, and 34% of those reporting emotional abuse indicated a period of time during which they did not remember the abuse.Conclusion: Results indicate that the CTHC reliably differentiated between participants reporting past sexual abuse and those who did not. Mounting evidence continues to support that adult symptom profiles are able to indicate that some form of trauma is likely to have occurred in the past; however, differentiating between types of abuse based on symptom profiles may be impossible.Spanish abstract was not available at time of publication.     

Childhood sexual violence in Zimbabwe: Evidence for the epidemic against girls

Sexual abuse during childhood is a public health and human rights concern throughout the world, including Sub-Saharan Africa. In 2011, Zimbabwe initiated national prevalence data collection on violence against children to inform government policy and programs. We interviewed 567 females and 589 males, aged 18–24 years following standardized and previously tested survey methods from the region. Of females 32.5%, and of males 8.9%, reported experiencing sexual violence before age 18. Most female (62.7%) and male (47.9%) victims of sexual violence experienced more than one incident of sexual violence prior to age 18 years. Three in four females (77.7%) and one in four males (26.7%) of those who experienced sexual violence reported that the first incident was perpetrated by a boyfriend or girlfriend. Few victims received professional help (2.7% of females and 2.4% of males who had reported experiencing sexual violence). Violence against girls is at epidemic levels in Zimbabwe. Most sexual violence against girls occurs within the context of peer relationships. Child victims who seek potentially life-saving support tend not to receive it. This study is evidence of a national public health and child rights emergency in the country and a case for increased, longer-term investment by the government and its development partners in policy reform for enhancing adolescent girls’ empowerment and protection.     

Genital examinations for alleged sexual abuse of prepubertal girls: findings by pediatric emergency medicine physicians compared with child abuse trained physicians

OBJECTIVE: This study compares abnormal genital examination findings made by pediatric emergency medicine (PEM) physicians to examinations by physicians with training in child sexual abuse in the evaluation of prepubertal girls for suspected sexual abuse. METHOD: A prospective study was performed following the genital examination by a PEM physician of prepubertal girls suspected of being sexually abused. A physician with training in child sexual abuse re-examined those girls whose examinations were interpreted as abnormal by the PEM physicians. The findings and interpretations of the PEM physician were then compared to those by the physicians with training in child abuse. RESULTS: Between October 1994 and October 1998, 46 patients diagnosed by PEM physicians with nonacute genital findings indicative of sexual abuse were re-examined by a physician with training in child abuse. The follow-up examinations were done 2 days-16 weeks (mean 2.1 weeks) after the emergency department visit. The physicians with training in child abuse concluded that only eight of these children (17%) showed clear evidence of abuse. Normal findings were noted in 32 children (70%), nonspecific changes were noted in 4 children (9%), and 2 children (4%) had findings that are more commonly seen in abused children than nonabused children but are not diagnostic for abuse (concerning for abuse). CONCLUSIONS: There was poor agreement between the pediatric emergency medicine physicians and the physicians with training in child sexual abuse. This study suggests that emergency medicine physicians should consider additional training in this area. In addition, all children with abnormal ED examinations should have follow-up examinations by a child abuse trained physician.     

Resilience to adult psychopathology following childhood maltreatment: evidence from a community sample

OBJECTIVE: Child abuse is an important risk for adult psychiatric morbidity. However, not all maltreated children experience mental health problems as adults. The aims of the present study were to address the extent of resilience to adult psychopathology in a representative community sample, and to explore predictors of a good prognosis. METHODS: Data are drawn from a follow-up of the Isle of Wight study, an epidemiological sample assessed in adolescence and at midlife. Ratings of psychiatric disorder, peer relationships and family functioning were made in adolescence; adult assessments included a lifetime psychiatric history, personality and social functioning assessments, and retrospective reports of childhood sexual and physical abuse. RESULTS: Ten percent of individuals reported repeated or severe physical or sexual abuse in childhood. Prospective measures revealed increased rates of adolescent psychiatric disorders in this group. Rates of adult psychopathology were also high. A substantial minority of abused individuals reported no mental health problems in adult life. Resilience of this kind was related to perceived parental care, adolescent peer relationships, the quality of adult love relationships, and personality style. CONCLUSION: Good quality relationships across childhood, adolescence and adulthood appear especially important for adult psychological well being in the context of childhood abuse.