Child sexual abuse prevention programs: do they decrease the occurrence of child sexual abuse?

OBJECTIVE: The primary goal of the current study was to determine whether rates of child sexual abuse differed among undergraduate women who either had or had not participated in a sexual abuse prevention program during childhood. A secondary goal was to determine whether differences emerged in sexual satisfaction or avoidance of sexual activity between those women who had or had not participated in such a program. METHOD: Eight hundred and twenty-five women undergraduates from a New England state university filled out a survey on "sexual experiences" for research credit. Respondents were asked detailed questions regarding past histories of child sexual abuse and participation in school-based prevention programs during childhood. Additionally, they responded to questions about their current sexual satisfaction and sexual behaviors. RESULTS: Sixty-two percent of the sample reported having participated in a "good touch-bad touch" sexual abuse prevention program in school. Eight percent of respondents who reported ever having had a prevention program also reported having been subsequently sexually abused, compared to 14% of respondents who did not ever have a prevention program. No differences were found in adult sexual satisfaction or on behavioral measures of sexual activity between those respondents who had and had not participated in a prevention program. CONCLUSIONS: This is the first study to find that school-based child sexual abuse prevention programs are associated with a reduced incidence of child sexual abuse. Additionally, contrary to concerns voiced in the literature, there was no evidence that prevention programs are associated with decreased sexual satisfaction or avoidance of sex in adulthood. Implications of the results for further study are discussed.     

Social workers’ views on pre-trial therapy in cases of child sexual abuse in South Africa

This study sought to explore anecdotal reports that social workers in South Africa are often advised to postpone therapy with child complainants of sexual abuse until after the child's testimony, based on concerns of legal professionals that therapeutic interventions could influence the child's testimony. Applying purposive sampling and a qualitative research study, individual and focus group interviews were conducted with 18 social workers and one psychologist that provide therapeutic services to child complainants of sexual abuse in the Gauteng province. Interviews were audio-recorded, transcribed and independently analyzed by both researchers, performing thematic analysis. Emerging themes include a lack of directives in terms of the provision of pre-trial therapy for child victims of sexual abuse, current practices and challenges in this regard. Recommendations for the way forward are presented. Limitations and future research will be discussed.     

Social history: A qualitative analysis of child abuse pediatricians’ consultation notes

BackgroundChild abuse pediatricians (CAPs) are often consulted for injuries when child physical abuse is suspected or when the etiology of a serious injury is unclear. CAPs carefully evaluate the reported mechanism of the child’s injury and the medical findings in the context of the child’s family and social setting to identify possible risk and protective factors for child abuse and the need for social services. It is unknown what population risk indicators along with other social cues CAPs record in the social history of the consultation notes when assessing families who are being evaluated for child physical abuse.Participants and settingThirty-two CAPs representing 28 US child abuse programs.MethodsParticipants submitted 730 completed cases of inpatient medical consultation notes for three injury types: traumatic brain injury, long bone fracture, and skull fracture in hospitalized children 4 years of age and younger. We defined a priori 12 social cues using known population risk indicators (e.g., single mother) and identified de novo 13 negative (e.g., legal engagement) and ten positive social cues (e.g., competent parenting). Using content analysis, we systematically coded the social history for the social cues.ResultsWe coded 3,543 cues resulting in a median of 7 coded cues per case. One quarter of the cues were population indicators while half of the cues were negative and one quarter positive.ConclusionsCAPs choose a wide variety of information, not always related to known population risk indicators, to include in their social histories.     

Test balloons? Small signs of big events: A qualitative study on circumstances facilitating adults’ awareness of children's first signs of sexual abuse

This research examined caregivers’ awareness of children's first signs of sexual abuse. The aim was to explore circumstances that facilitate adults’ awareness of first signs in everyday natural settings. Data were obtained from a Norwegian university hospital's outpatient specialty mental health clinic. Included were all cases (N = 20) referred during a two-year period for treatment after the disclosure of sexual abuse that was reported to the police and child protective service. Nonabusing caregivers’ awareness of first signs were recollected in hindsight as part of therapy. Qualitative analysis was conducted to capture caregivers’ experiences. As identified by caregivers, all children gave signs. Thereafter, children either stopped, delayed, or immediately disclosed sexual abuse. At first signs, each child had time and attention from trusted adults, connection to the abuser, and exhibited signs of reservation against that person or related activities. Then, if met with closed answers, first signs were rebuffed as once-occurring events. If met with open answers and follow-up questions, children continued to tell. Unambiguous messages were prompted only in settings with intimate bodily activity or sexual abuse related content. In sum, when trusted adults provided door-openings, children used them; when carefully prompted, children talked; when thoughtfully asked, children told. The study suggests that children's signs of sexual abuse can be understood as “test balloons” to explore understanding and whether anything is to be done. A disclosing continuation hinges on the trusted adult's dialogical attunement and supplementary door-openings. Divergent from an idea of behavioural markers, or purposeful versus accidental disclosures, this study calls for a broader attention: Moments of first signs are embedded in dialogue. A uniqueness at moments of first signs appears: Both to form such moments and to transform them into moments of meeting for joint exploration and telling, hinge upon how trusted caregivers scaffold opportunities for the child to disclose. Subsequently, support offers need to be addressed not only to strengthen children to tell, but also for caregivers and professionals to take into account the necessity of a dialogically oriented sensitivity towards children, both for telling to occur and for hearing to take place.     

A historical comparison of Australian lawyers’ strategies for cross-examining child sexual abuse complainants

Many child sexual abuse complainants find the adversarial trial process so distressing that they say they would never report abuse again. Their concerns stem largely from cross-examination, in which the lawyer acting for the accused attempts to discredit their evidence. We examined whether—and if so, how—Australian defense lawyers’ approaches to cross-examining child sexual abuse complainants have changed meaningfully over the past 60 years. To do this, we systematically evaluated cases that were prosecuted in the 1950s, comparing them to a matched set of cases from the turn of the twenty-first century. Despite the intervening law reforms designed to improve complainants’ experience in court, we found that, relative to their historical counterparts, contemporary child complainants of sexual abuse are actually subjected to far lengthier cross-examinations involving a much broader range of strategies and associated tactics. These findings have important implications for future legal practice and reform, and for the way in which these are evaluated.     

Therapeutic interventions with child survivors of sibling sexual abuse: The professionals’ perspective

BackgroundSibling sexual abuse (SSA) is a continuum of childhood sexual behaviors that do not fit age-appropriate curiosity. SSA may be the most prevalent, longest lasting form of intrafamilial sexual abuse – and the least reported, studied and treated.ObjectiveThis exploratory qualitative study examined the experience of intervention with SSA survivors from the perspective of mental health professionals, and explored their major therapeutic challenges.Participants and settingThe sample consisted of 20 Jewish Israeli mental health professionals working in private clinics or public social welfare services who had experience with SSA.MethodsSemi-structured interviews focusing on the characteristics of SSA events, perceptions about the effects of abuse, intervention priorities and therapeutic challenges compared to other types of child abuse.ResultsProfessionals working with SSA survivors are preoccupied with the need to provide them with physical and emotional protection, as well as to help them process the abuse narrative. They also find themselves dealing with survivors who do not experience themselves as victims despite external evidence of abuse, or with the need to reconcile their perception of the sexual relationship as mutual, as opposed to the formal requirement to differentiate between “offender” and “victim”. In either case, the reality of these survivors can be just as painful as in other SSA cases.ConclusionsThe complexity of SSA calls for unique intervention skills, including working with survivor narratives that do not fit the victim/offender dichotomy on one hand and that do not minimize the potentially harsh consequences of SSA on the other.     

What prevents Chinese parents from reporting possible cases of child sexual abuse to authority? A holistic-interactionistic approach

The reporting of suspected CSA cases to authorities in a timely manner is important in preventing continued abuse and protecting abused children at early ages. The current study seeks to explore parents’ intentions of reporting their own children’s CSA experiences to authorities as well as their reporting willingness when they become aware of possible CSA cases happening to children in other families. Two rounds of semi-structured interviews were conducted among a sample of 26 parents in Beijing; these parents were purposefully selected so as to be diverse in terms of gender, age, and socioeconomic status. The data were analyzed thematically. The findings showed that the reporting of suspected CSA to authorities was a choice made by only a few Chinese parents; it was often even a last resort. By using a holistic-interactionistic approach, the interaction between Chinese parents’ intentions of reporting CSA and the Chinese socio-cultural context was analyzed as a dynamic and continuously ongoing process. The impacts of the definition and perceptions of CSA on reporting, the balance of children’s rights and parents’ power, and the double effect of informal social control are discussed. The implications, both locally and globally, are also discussed.     

School’s out: a comprehensive follow-up study on parents’ perceptions of their child’s school

This longitudinal study set out to examine the changes that took place in parents’ evaluations of their child’s school in the course of the child’s complete 9-year-long compulsory education. Over the follow-up period, academically educated and vocationally educated mothers and fathers (N = 326) were asked to indicate their degree of satisfaction with aspects of their child’s school every 2 years. It was found that the level of parental satisfaction was fairly high at the start, that the general decreasing trend was gradual rather than abrupt, and that the proportion of dissatisfied parents remained low and stable. A pattern of differences emerged to suggest that the parents’ perceptions were structured by their social-psychological distance from the school as measured by their social positions; for instance, the vocationally educated parents, fathers in particular, displayed less satisfaction than the academically educated ones.     

Does the impact of child sexual abuse differ from maltreated but non-sexually abused children? A prospective examination of the impact of child sexual abuse on internalizing and externalizing behavior problems

Child sexual abuse (CSA) continues to be a significant problem with significant short and long term consequences. However, extant literature is limited by the reliance on retrospective recall of adult samples, single-time assessments, and lack of longitudinal data during the childhood and adolescent years. The purpose of this study was to compare internalizing and externalizing behavior problems of those with a history of sexual abuse to those with a history of maltreatment, but not sexual abuse. We examined whether gender moderated problems over time. Data were drawn from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) at ages 4, 6, 8, 10, 12, 14, and 16 (N = 977). The Child Behavior Checklist was used to assess internalizing and externalizing problems. Maltreatment history and types were obtained from official Child Protective Services (CPS) records. Generalized Estimating Equations (GEE) were used to assess behavior problems over time by maltreatment group. Findings indicated significantly more problems in the CSA group than the maltreated group without CSA over time. Internalizing problems were higher for sexually abused boys compared to girls. For sexually abused girls internalizing problems, but not externalizing problems increased with age relative to boys. This pattern was similar among maltreated but not sexually abused youth. Further efforts are needed to examine the psychological effects of maltreatment, particularly CSA longitudinally as well as better understand possible gender differences in order to best guide treatment efforts.     

Parents’ perception of child behavior,parenting stress,and child abuse potential: Individual and partner influences

Based on the Social Information Processing model of parenting risk for child abuse, the present study examined the associations between mothers’ and fathers’ perception of child behavior and child abuse potential, as well as whether parenting stress mediates the association between these constructs. Two hundred and fifty-nine mother-father couples raising preschool children answered the Child Behavior Checklist (CBCL), the Parenting Stress Index (PSI), and the Child Abuse Potential Inventory (CAPI). The results of dyadic path analysis showed that perception of child behavior was related to heightened parenting stress and abuse potential in both mothers and fathers. Concerning partner effects, we found that mothers’ perception of child behavior problems was positively associated with fathers’ parenting stress and that the higher the mothers’ distress, the higher the fathers’ risk of physical abuse. Finally, parenting distress partially mediated the association between parents’ perception of child behavior and child abuse potential, with mothers’ perception of their children as problematic showing a significant indirect effect through distress on their own abuse risk and on fathers’ CAP as well. These findings suggest that parental distress may represent a critical mechanism by which parents’ negative views of their children contribute to abuse potential. Moreover, mothers seem to influence fathers’ tendency towards abusive behaviors.     

Legal decision–making in child sexual abuse investigations: A mixed–methods study of factors that influence prosecution

Prosecution of child sexual abuse cases is an important aspect of a community's response for holding perpetrators accountable and protecting children. Differences in charging rates across jurisdictions may reflect considerations made in prosecutors' decision–making process. This mixed–methods, multiphase study used data from a Children's Advocacy Center in a suburban county in the Southern United States to explore the factors associated with child sexual abuse cases that are accepted for prosecution and the process followed by prosecutors. Data were sequentially linked in three phases (qualitative-quantitative-qualitative), incorporating 1) prosecutor perceptions about what case characteristics affect charging potential, 2) 100 case records and forensic interviews, and 3) in–depth reviews of cases prosecuted. Content analysis was used to identify influential case elements, logistic regression modeling was used to determine factors associated with a decision to prosecute, and framework analysis was used to further confirm and expand upon case factors. Overall, findings indicate that prosecution is most strongly predicted by caregiver support and the availability of other evidence. The decision to prosecute was found to include a process of ongoing evaluation of the evidence and determination of a balanced approach to justice. The decision to prosecute a case can be influenced by strong and supportive investigative practices. An important implication is that interaction among multidisciplinary professionals promotes communication and efforts, further enhancing discretion about potential legal actions.     

Pre-service special education teachers’ professionalism and preparation in terms of child sexual abuse

This study aimed at examining Jordanian pre-service special education teachers’ professionalism and preparation on the topic of child sexual abuse (CSA). Qualitative research data from interviews with 20 pre-service special education teachers were analysed using thematic analysis. The results showed that these participants generally hold avoiding behaviour toward speaking about CSA as it is an unspoken taboo. Participants also hold low levels of professionalism on the topic of CSA. The results also demonstrate that they felt that their preparation programme is inadequate and desired more content and pedagogy courses that relate to CSA. Implications and recommendations are presented in light of the study findings.     

Counselor educators’ views on cognitively complex trainees: A Q method study

Our Q method exploration of counselor educators’ perspectives of minimally acceptable cognitive complexity (CC) in trainees at the end of internship yielded two factors: Trainee's Conceptual Integration Ability and Trainee's Ability to Apply Integrated Knowledge. Implications for teaching, supervision, and research pertinent to assessment of and enhancement of CC conclude.     

Childhood sexual abuse and substance abuse: A gender paradox?

We examine associations between childhood sexual abuse (CSA) and substance abuse, the role of mental health indicators as mediators in these associations and whether or not associations differ by gender. Data are from 14,063 respondents aged 18–76 years from the 2004–2005 Canadian Gender, Alcohol, and Culture: An International Study (GENACIS). Multiple logistic regression models were used to examine associations between CSA and substance abuse variables, controlling for socio-demographic factors. Odds were adjusted by indicators of mental health to assess if these variables mediated associations between CSA and substance abuse. Tests of interactions between sex and CSA were conducted to see if gender differences exist in associations. In 2004/2005, CSA was reported by 14% of women and 5% of men. CSA was associated with heavy drinking, hazardous drinking, and the use of marijuana, other illicit drugs, and off-label drugs. Associations were only very marginally attenuated when controlling for depression and self-perceived emotional/mental health. In all cases previously observed significant associations persisted. Evidence of gender differences in associations between CSA and substance abuse was negligible. Preventing CSA may also reduce substance abuse.     

“I have the right to feel safe”: Evaluation of a school-based child sexual abuse prevention program in Ecuador

BackgroundChild sexual abuse (CSA) is a complex public health problem that has lifelong implications for children’s wellbeing. Interventions may provide children strategies to protect themselves against CSA, but few have been studied in Latin America.ObjectiveEvaluate the immediate and medium-term impact of a 10-week educational program on children’s knowledge of CSA self-protection strategies in Ecuador.Participants and settingsChildren aged 7–12 years from six public elementary schools in Ecuador were cluster-randomized to either receive the intervention between October and November 2016 (Group 1, k = 4) or between March and April 2017 (Group 2, k = 2).MethodsTo assess CSA knowledge, a random sample of students completed a questionnaire at three time points: 1) initial: before any group received the intervention, 2) intermediate: immediately after Group 1 completed the program but before Group 2 started it, and 3) final: after Group 2 completed the program. We evaluated changes in scores using mixed linear regression models with school as a clustering variable and adjusted degrees of freedom (df = 4).ResultsPre-post effect estimates at program completion adjusted for age, sex and clustering by school were 6.5% (95% CI: 2.9, 10.0) and 6.8% (95% CI 3.0, 10.7) for Groups 1 and 2, respectively. Scores did not change among children who had not yet received the intervention at intermediate evaluation (0.94%, 95%CI: −6.0, 7.9). Children in Group 1 maintained the scores six months after the program ended.ConclusionsThe self-protection program increased and maintained CSA knowledge six months after the intervention finished.     

Barriers and facilitators affecting self-disclosure among male survivors of child sexual abuse: The service providers’ perspective

Research regarding child sexual abuse (CSA) indicates significant gender differences in disclosure rates, with males less likely to disclose their abuse compared to females. CSA can have lasting impact on a children’s emotional, physical, and psychological wellbeing. While service providers play an instrumental role in providing care and support for male CSA survivors, little is known about their perceptions and experiences related to disclosure among these men. The aim of this qualitative study was to explore service providers’ perceptions and awareness of disclosure-related barriers and facilitators amongst male CSA survivors. Individual interviews were conducted with eleven service providers. Study findings reveal four key themes related to the disclosure process among male CSA survivors: (a) personal characteristics, (b) interpersonal relations, (c) institutional elements, and (d) societal norms. Findings indicate that service providers understand and respond to complex challenges associated with disclosure of CSA among this marginalized population. Study findings demonstrate the need for additional research on the specific issues of gender bias and stigma associated with male sexual abuse. Along with their empirical significance, these findings can be used to develop more tailored public health and social service-related programming for male CSA survivors, their families, and the broader community to promote a safer and more supportive environment in which to discuss these sensitive and important issues. Recommendations to service providers are discussed.