Further abuse of sexually abused children

OBJECTIVE: To determine the incidence of re-abuse in children known to have been sexually abused and to find factors that increase the risk of re-abuse. METHOD: The study group consisted of 183 children with substantiated sexual abuse who presented to two children's hospitals' Child Protection Units in Sydney, Australia during 1988 through 1990. At intake, when the children were aged between 5 years and 15 years, data about the child, the family, and the nature of the index sexual abuse were collected. Six years after presentation for the abuse, records of the Department of Community Services were checked to see if any of the young people had been the subject of substantiated notifications for abuse/neglect before and after intake to the study. Predictors of notifications for abuse/neglect after presentation for the index sexual abuse were identified. RESULTS: Of the sexually abused young people, nearly one in three were the subject of subsequent substantiated notifications to the Department of Community Services for some form of child abuse and neglect or behavior which placed them at risk of harm. Later notifications for abuse/neglect were predicted by notifications for emotional abuse before the index sexual abuse (adjusted RR = 4.88, CI: 1.43 to 16.65), severity of the index sexual abuse (p = .03), and the number of changes in the child's primary caregivers before intake (p = .03). Approximately one in six of the sexually abused young people were notified for sexual abuse after intake to the study. One in 10 also had prior notifications for sexual abuse. Sexual abuse notifications after study intake were predicted by caregiver changes before intake (p = .01) and whether or not there were notifications for emotional abuse before the index sexual abuse (adjusted RR = 3.40, CI: 1.05 to 11.02). CONCLUSIONS: Revictimization of children appears to be a marker of ongoing family dysfunction. Intervention in child sexual abuse needs to consider a range of risk factors associated with re-abuse and, in particular, should focus on family functioning if further abuse is to be prevented.     

Discourses of education,protection, and child labor: case studies of Benin,Namibia and Swaziland

This article analyses discontinuities between local, national and international discourse in the fields of education, protection of children, and child labor, using Benin, Namibia and Swaziland as case studies. In Benin, child abuse and child labor are related to poverty, whereas in Namibia and Swaziland they are also interrelated with HIV/AIDS. In these countries, the notion of childhood is seen as continuous with adulthood, and the change from education to work is not abrupt and age-determined, but a smooth transition. The international discourse defines children in binary terms (child or adult), and promotes free and compulsory education for children, without recognizing the direct and indirect costs of education. Projects based on an international discourse may have little relevance in a poverty context where it is natural to make children work to ensure food safety. Local communities consider children from a logic of community survival; the external aid agencies consider them from a logic of individual children's rights. There is a need to find a bridge between these two interpretations of childhood.     

Active surveillance of child abuse fatalities.

Monitoring abuse related deaths of infants and young children yields information necessary to the formulation of sound public policy. Birth and death certificates were correlated with information in the state Child Abuse and Neglect Registry on 104 abuse related fatalities. Significant findings include: very young age of parents at the first pregnancy; high rate of single parenthood; significantly lower educational achievement of victims' mothers; late, inadequate prenatal care; complications during pregnancy; and low birth weight among victims. The authors suggest Active Surveillance as a model for collecting information pertaining to child fatalities. Using Active Surveillance, a review team examines information from state agencies pertaining to children and families to review or determine cause of death and to collect demographic data on victims and perpetrators. Active Surveillance decreases the possibility of misidentifying abuse related deaths as accidental, and allows state agencies to follow abuse fatalities, collecting pertinent information and adjusting policy accordingly. The authors argue that, using Active Surveillance, states and nations may monitor success in preventing child abuse fatalities just as they now use infant mortality to monitor progress in public health, thus creating a stable and reliable standard for measuring progress in eliminating one type of child abuse.     

Child sexual abuse in sub-Saharan Africa: a literature review

OBJECTIVE: This article reviews the English-language literature on child sexual abuse in sub-Saharan Africa (SSA). The focus is on the sexual abuse of children in the home/community, as opposed to the commercial sexual exploitation of children. METHODS: English language, peer-reviewed papers cited in the Social Sciences Citation Index (SSCI) are examined. Reports from international and local NGOs and UN agencies are also examined. RESULTS: Few published studies on the sexual abuse of children have been conducted in the region, with the exception of South Africa. Samples are predominantly clinical or University based. A number of studies report that approximately 5% of the sample reported penetrative sexual abuse during their childhood. No national survey of the general population has been conducted. The most frequent explanations for the sexual abuse of children in SSA include rapid social change, AIDS/HIV avoidance strategies and the patriarchal nature of society. Child sexual abuse is most frequently perpetrated by family members, relatives, neighbors or others known to the child. CONCLUSIONS: There is nothing to support the widely held view that child sexual abuse is very rare in SSA-prevalence levels are comparable with studies reported from other regions. The high prevalence levels of AIDS/HIV in the region expose sexually abused children to high risks of infection. It is estimated that, approximately.6-1.8% of all children in high HIV-incidence countries in Southern Africa will experience penetrative sexual abuse by an AIDS/HIV infected perpetrator before 18 years of age.     

Child sexual abuse prevention education: A review of school policy and curriculum provision in Australia

The past four decades have seen increasing public and professional awareness of child sexual abuse. Congruent with public health approaches to prevention, efforts to eliminate child sexual abuse have inspired the emergence of prevention initiatives which can be provided to all children as part of their standard school curriculum. However, relatively little is known about the scope and nature of child sexual abuse prevention efforts in government school systems internationally. This paper assesses and compares the policies and curriculum initiatives in primary (elementary) schools across state and territory Departments of Education in Australia. Using publicly available electronic data, a deductive qualitative content analysis of policy and curriculum documents was undertaken to examine the characteristics of child sexual abuse prevention education in these school systems. It was found that the system-level provision occurs unevenly across state and territory jurisdictions. This results in the potential for substantial inequity in Australian children’s access to learning opportunities in child abuse prevention education as a part of their standard school curriculum. In this research, we have developed a strategy for generating a set of theoretically-sound empirical criteria that may be more extensively applied in comparative research about prevention initiatives internationally.     

Medical evaluation referral patterns for sexual abuse victims.

It has been recommended that all children suspected of being sexually abused should have medical evaluations. To better understand practices and perceptions of child sexual abuse medical evaluations, a survey was conducted of 579 professionals attending educational programs on child sexual abuse; 85.8% (N = 497) responded. Half (50%) of the respondents reported no previous training in child sexual abuse. Of the 336 nonphysician professionals, 194 (57.7%) were in positions where they make referrals of the victims, and 69% of these did not refer all of the children they saw for medical evaluations. The first referral choice for medical evaluation was most often to the victim's primary physician (57%). For those professionals who did not refer all alleged victims for medical evaluation, neither the victims' age, gender, nor accessibility to care were generally considered relevant in determining the decision to refer. However, the type of abuse and presence of physical and psychological symptoms were considered relevant in making the decision. The majority indicated that the findings of the medical exam were very useful in substantiating or refuting the allegation of abuse. Further training for both medical and nonmedical professionals is needed to increase awareness of the need for and implications of the medical evaluation if children are to receive comprehensive assessments. Physicians may play an active role in this process through education of professionals and provision of care.     

Educational and psychological problems of abused children

The findings of this study tend to confirm the hypothesis that abused children are found to be significantly different from nonabused children in academic achievement, placement in classes for the emotionally disturbed and for the educable mentally retarded. The data also confirm the hypothesis that abused and neglected children are placed in special facilities more frequently than children who have not been adjudged as abused. Further, abused and neglected children were reported to exhibit behaviors indicative of psychological problems. Within each of the dimensions investigated, abused and neglected children were found to have significant problems.In light of the significant differences found in this study, we find substantial support for the projects being supported by the National Center for Child Abuse and Neglect designed to involve the schools in the United States in the battle against children abuse and neglect. Especially important is the project of the Education Commission of the States designed to create an awareness among school systems, professional teacher organizations, and state and local legislative governing bodies of their potential in the battle against child abuse and neglect.In light of the loss of human potential as well as the increased costs involved in providing special classes for the abused and neglected child, allocation of resources to involve schools and school personnel as a part of the multidisciplinary team concerned with child abuse and neglect seems well justified. Additionally, the allocation of fiscal resources for research designed to secure data regarding the sequelae of child abuse is also amply justified.     

Child abuse and neglect in American Indian communities

Child abuse and neglect have recently been found to occur among American Indians at rates comparable to other American population groups. Little is known about the clinical spectrum of Indian maltreatment, the psychodynamics and effective treatment modalities. Cultural misunderstanding, modernization, poverty, situational stress, poor parenting skills because of early break-up of Indian families, alcoholism, unusual perceptions of children, handicapped children, and divorce constitute factors associated with maltreatment in cases cited. Old solutions of removing children from families were largely inappropriate and ineffective and are being replaced by local efforts to develop foster homes, supportive family services, and legal procedures to protect children. Communication between agencies involved and mistrust of outsiders plus a lack of trained personnel and available community resources continue to pose major barriers to effective treatment and prevention efforts. Recent federal policies and laws clearly place the responsibility for child welfare in the hands of Indian tribes and tribal courts. The non-Indian health professional has an important but limited role in providing technical expertise and in aiding development of community resources, taking care to support but not usurp the emerging leadership of Indian people.     

The effect of Alaska's home visitation program for high-risk families on trends in abuse and neglect

OBJECTIVES: At 6 sites serving 21 communities, Alaska implemented Healthy Families Alaska, a home visitation program using paraprofessionals designed to decrease child abuse and neglect. The primary study objective was to compare changes over time in Child Protective Services outcomes by Healthy Families Alaska enrollment status. METHODS: Enrollment status was linked to birth certificates for birth years 1996-2002 which in turn was linked to the Alaska Child Protective Services database for outcome years 1996-2004. All children were followed through the study databases until age 2 years. RESULTS: There were 40,099 children born during 1996-2002 to residents of Healthy Families Alaska communities and 985 were enrolled in the program. Physical abuse referrals among enrolled children decreased from 73 to 42 per 1000 child-years of follow-up from 1996-1998 to 2000-2002 (p=.005); all of this decrease occurred among children who received 20 or more home visitations. This decrease may have been unrelated to program impact as a similar decrease in referral was seen among unenrolled high-risk children. Compared to unenrolled high-risk children, enrolled children had a modest decrease in the proportion with substantiated neglect but no difference in the proportion with neglect referral or physical abuse referral or substantiation. CONCLUSIONS: Little evidence exists that Alaska's home visitation program had a measurable impact on child maltreatment outcomes. PRACTICE IMPLICATIONS: Within Alaskan communities that had a home visitation program targeting families at high risk for child abuse, changes in Child Protective Services outcomes among children less than 2 years of age were followed over time by program enrollment status. Enrollment was associated with a substantial decrease in physical abuse referrals, but a similar decrease was seen among unenrolled high-risk children. No improvement was seen in physical abuse substantiation. A greater number of home visitations was not associated with fewer abuse outcomes. This work supports most of the recent literature, which questions the field effectiveness of home visitation programs. In combination with other studies, the current work may lead decision-makers and funding agencies to re-examine the usefulness of home visitation programs, particularly those using a methodology similar to that implemented in Alaska.     

儿童性虐待认定及其存在的问题

儿童性虐待已经成为世界范围内的公共卫生问题,各国对儿童性虐待的流行学调查显示一致的高流行率及某些共同的特点,儿童性虐待由于具有特殊的创伤特征以及虐待形式的多样化而存在认定困难。建立专业的儿童性虐待评估机构是减少受虐儿童反复受到伤害,降低其创伤后障碍风险的有效途径。性科学教育及普法教育是提高人们自我保护和保护他人意识的关键,学校是性教育的主要场所,同时需建立家庭、学校、社会三位一体的安全责任体系。     

Community characteristics associated with child abuse in Iowa

PROBLEM: Various demographic and community characteristics are associated with child abuse rates in national and urban samples, but similar analyses have not been done within rural areas. This study analyzes the relationships between reported and substantiated rates of child abuse and county demographic, health care resource and social services factors in a predominantly rural state in the US. METHODS: County-level data from Iowa between 1984-1993 were analyzed for associations between county characteristics and rates of child abuse using univariate correlations and multivariate stagewise regression analysis. Population-adjusted rates of reported and substantiated child abuse were correlated with rates of children in poverty, single-parent families, marriage and divorce, unemployment, high-school dropouts, median family income, elder abuse, birth and death rates, numbers of physicians and other healthcare providers, hospital, social workers, and number of caseworkers in the Department of Human Services. RESULTS: Rates of single-parent families, divorce and elder abuse were significantly associated with reported and substantiated child abuse in multivariate analysis, while economic and most health care factors were not. Reporting and substantiation rates differed across districts after adjustment for multiple factors including caseworker workload. CONCLUSIONS: In this rural state, family structure is more significantly associated with child abuse report and substantiation rates than are socioeconomic factors. The level of health care resources in a county does not appear to affect these rates.     

The characteristics of reports to the police of child sexual abuse and the likelihood of cases proceeding to prosecution after delays in reporting

Delays in disclosing and reporting child sexual abuse to the police are common, particularly among males and those who have been abused by clergy and others in a position of trust. This study, commissioned by the Royal Commission into Institutional Responses to Child Sexual Abuse, examined the patterns of timely and delayed reporting of sexual offences against children, and the likelihood of legal action commencing. De-identified unit record data for all sexual offences against children reported to the police over 20 years were obtained from official crime statistics agencies in two Australian states. While there were similarities between the two states in terms of the influence of public inquiries on reporting numbers over this period, and in the factors associated with delayed reporting, there were substantial differences in the likelihood of legal action being taken in cases reported by a child or adult complainants. In one state, legal action was more likely with increasing delay, until the delays extended to 10–20 years, after which the likelihood of legal action decreased. In the other state, the pattern was quite different – reports of sexual assault were somewhat more likely to result in legal action with immediate reporting. The least likely to proceed were cases involving young children in more recent years; long delays into adulthood were not necessarily adverse for prosecution.     

Mobilization of community resources to work with abusive and neglectful families: Community organization in New York state

This article describes the community organization experience of the Family Life Development Center at Cornell University in connection with the federally financed Resource Center on Child Abuse and Neglect which it has operated since 1975. Early on, the Center decided to concentrate its efforts on organizing local task forces on child abuse and neglect which would work at the community level to improve services for families and children afflicted with the problem. As a result, over 50 such groups were organized and they have stimulated creation of over 100 new services including Parents Anonymous chapters, parent aides, multidisciplinary teams and parenting education projects. In short, the local community organization approach enabled a small state level staff to stimulate a major mobilization of resources for child abuse and neglect at the community level throughout the state. The process began with several “trial and error” experiences in rural New York. This led to technical assistance in task force formation for a dozen more counties and finally to regional workshops on task force organizations. The process culminated with formation of a statewide federation of the local groups. The Center is now implementing the approach in New Jersey, Puerto Rico and the Virgin Islands.     

Referrals to a hospital-based child abuse committee: a comparison of the 1960s and 1990s

OBJECTIVE: Although reports of child maltreatment have increased yearly since national data were first collected in 1976, little information is available about changes in the characteristics of children reported. Therefore, to examine changes over time in recognition and reporting in a medical setting, we compared referrals to a hospital-based child abuse committee in the late 1960s and early 1990s. DESIGN: Retrospective, cross-sectional review of medical records and logs of the hospital's child abuse committee. SETTINGS: Ambulatory, emergency, and inpatient services at Yale-New Haven Hospital. Patients: Medical records were reviewed for 101 of the 165 children referred to the child abuse committee in 1968-1969 (early group) and 107 of the 843 children referred in 1990-1991 (late group). Cases of sexual abuse were excluded. RESULTS: Referrals for nonsexual abuse cases increased from 80 children per year in the early group to 181.5 per year in the late group; the late group was characterized by a larger number of newborn referrals (1% vs. 52%, p < .001). When non-newborns were compared, the two groups were similar with respect to gender and race, but the late group had fewer patients with private insurance (31% vs. 12%, p < .05). The late group also had more female-headed households (32% vs. 67%, p < .05) and more parents with a history of substance abuse (4% vs. 49%, p < .001). Excluding newborns, who were all classified as "at-risk," the types of problems were classified as abuse (41% early vs. 29% late), neglect (41% vs. 35%), and "at-risk" (16% vs. 35%). Although the types of injuries were similar: superficial injuries (20% vs. 16%), burns (9% vs. 8%), and fractures (6% vs. 4%), fewer maltreated children suffered physical injuries in the late group (71% vs. 49%, p < .05). CONCLUSIONS: A substantial change has occurred in referrals to the hospital's child abuse committee for abuse or neglect. Most referrals have become socially high-risk newborns and children or children with minimal injuries. This shift is likely due to broader definitions of maltreatment and earlier recognition of troubled families.     

Bachelor of Social Work (BSW) Students' Prior Sexual Abuse Victimization

This paper reports findings of an exploratory study surveying 61 students about their prior child sexual abuse victimization. Bachelor of Social Work (BSW) students were surveyed at the beginning and end of a child abuse course and results indicated that 19.7 % of the students reported being sexually abused during childhood. Results also indicated that taking a child abuse course may increase BSW students' self‐awareness regarding prior victimization. The paper discusses how prior child sexual abuse victimization can affect social work students, education, and practice.     

To a safer place? Victims of sexual abuse by females and their disclosures to professionals

OBJECTIVE: To explore the experiences of victims of female sex offenders with regard to disclosing sexual abuse to a professional, and importantly, the impact of professional responses on victims. METHOD: The data were derived from one-to-one semi-structured interviews with 14 (7 males, 7 females) victims of child sexual abuse by female perpetrators. Victims ranged in age from 23 to 59 years and were recruited through professional referrals or through poster advertisements in counseling services. Participants responded to questions on their family background, experience(s) of sexual abuse, experience(s) disclosing the sexual abuse to a professional, and the impact of professional responses. RESULTS: The majority of victims reported sexual abuse by their mothers. The average age of onset of the sexual abuse was age 5, lasting, on average, 6 years. Five participants reported experiencing severe, moderate and mild sexual abuse, four reported experiencing both severe and mild sexual abuse and five reported experiencing moderate and mild sexual abuse. The findings underscore the significance of professional intervention in relation to victim disclosures of sexual abuse by females. Professional responses to disclosures, whether positive or negative, appeared to have a crucial impact on the well-being of victims. Supportive professional responses including the acknowledgment and validation of victims' experiences of sexual abuse appeared to mitigate the negative effects of the abuse. In contrast, unsupportive responses where professionals minimized, or disbelieved victims' allegations of sexual abuse appeared to exacerbate the negative effects of the sexual abuse, ultimately inciting secondary victimization. CONCLUSION: The study highlights the need for the development and implementation of professional training initiatives to sensitize professionals to the issue of female sex offending and the intervention needs of victims. Failure to do so could have negative consequences for victims sexually abused by females.     

A model of intervention in child-abusing families: A wider systems view

This paper describes the application of some principles, taken from the modern psychotherapies by a therapeutic team, to the assessment and treatment of serious child abuse. Factors and dilemmas identified from the assessment and decision-making process are outlined, with particular reference to the roles of the various statutory and community agencies involved with such families. The paper demonstrates the ways in which the range of community and professional agencies may play a pathological role, unintentionally contributing to and maintaining child-abusing dynamics in families. The significance of dangerous unintended consequences of well-meaning agency interventions and of covert interagency activities are stressed.     

Child perpetrators--children who molest other children: preliminary findings

While the seriousness of sexual abuse by adolescents is finally beginning to receive adequate attention from the professional community, the existence of child perpetrators is largely dismissed and denied. Forty-seven boys between the ages of 4 and 13 are described who have molested children younger than themselves. Coercion was involved in all of the cases included in this study. These children had been treated in a program especially designed for child perpetrators at Children's Institute International in Los Angeles. Prior to their own sexually abusive behaviors, 49% of these boys had been sexually abused and 19% physically abused. The children all knew the people who victimized them. These male child perpetrators all knew the children they molested. In 47% of the cases the sexual abuse was of a sibling. The average number of victims of these children was 2.1 with a range of 1 to 7. The mean age at the time of perpetration was 8 years, 9 months. The mean age of the victims of these children was 6 years, 9 months. There was a history of sexual and physical abuse in the majority of the families of these children, as well as a history of substance abuse. This population is compared to adolescent perpetrators.