A taxonomy of duties to report child sexual abuse: Legal developments offer new ways to facilitate disclosure

Background: Child sexual abuse is undisclosed for many reasons that are resistant to change. Citizens can play an important role in disclosing cases of child sexual abuse to authorities. Professionals who deal with children also play a crucial role. Office-holders in organisations have a clear responsibility to prevent cover-ups of sexual abuse. Recently, some countries have created important new legal duties for adults to disclose child sexual abuse.Objectives: This article creates a contemporary taxonomy of duties to disclose cases of child sexual abuse, and explains their nature and justification.Participants and setting: Citizens, professionals dealing with children in the course of their work, and managers of child and youth-serving organisations.Methods: Legal analysis created a taxonomy of reporting duties. Analysis of these duties from perspectives of criminal jurisprudence, public health law, children’s rights and ethics considered their justification.Results: Seven legal duties now exist, in criminal law, civil law and child protection law. Some apply to all citizens; others to managers in organisations; others to professionals dealing with children in the course of their work. All the duties are directed to early detection of cases; some are directed towards prevention; and some are focused on avoidance of institutional corruption.Conclusions: These developments represent historic progress in overcoming normally intractable barriers to disclosure of cases of child sexual abuse. New legal duties are consistent with principles from criminal jurisprudence, public health law, children’s rights and ethics. Where adopted, societies should ensure the creation and maintenance of ecological conditions in which these duties can be observed.     

Australian undergraduate primary school student‐teachers’ responses to child sexual abuse and its mandatory reporting

This study aims to understand how primary school teachers, as mandatory reporters of child sexual abuse, are responding to child sexual abuse and its mandatory reporting, even though many teachers do not receive a compulsory course in Child Protection and its legal requirements in their pre‐service university training. A cohort of 81 Australian final fourth‐year Bachelor of Education (Primary) student‐teachers was asked about four aspects of it. Qualitative data gathered from these student‐teachers’ questionnaires provide important insights into their knowledge of child sexual abuse; their knowledge of Department of Education policy on it; their professional competence in mandatory reporting of it; and their recommended educational and professional training in it. The results show that all of these student‐teachers feel inadequately prepared to address child sexual abuse and mandatory reporting in schools, being unaware of both knowledge of it and the Department’s policy, even though many recognise the gravity of sexual abuse for the child survivor and the need, and seriousness, of child protection. Finally, these student‐teachers all want better training about these issues during their four‐year degree. In conclusion, these results, and some recommendations, may provide a guide for curriculum planners to design compulsory and appropriate pre‐service university courses to enhance student‐teachers’ knowledge, skills and competencies about child sexual abuse and its mandatory reporting.     

Vaginal inspection as it relates to child sexual abuse in girls under thirteen

Inclusion of vaginal inspection in all physical examinations resulted in doubling identification of cases of child sexual abuse. Forty-five of 247 girls under 13 years of age were admitted because sexual abuse had been reported. Of the 202 girls not suspected, 45 additional cases of sexual abuse were discovered by suspicious findings on vaginal inspection. The horizontal diameter of the vaginal opening exceeding 4 mm correlated in three of four instances with a confirming history for past sexual abuse. It is recommended that physical examination of young girls routinely include inspection of the vaginal opening. Pediatric caregivers need to teach themselves the parameters of the normal to protect those children who are suffering sexual abuse in their environment.     

Sh-h-h-h: representations of perpetrators of sexual child abuse in picturebooks

Children's picturebooks dealing with the topic of child sexual abuse first appeared in the early 1980s with the aim of addressing the need for age-appropriate texts to teach sexual abuse prevention concepts and to provide support for young children who may be at risk of or have already experienced sexual abuse. Despite the apparent potential of children's picturebooks to convey child sexual abuse prevention concepts, very few studies have addressed the topic of child sexual abuse in children's literature. Based on a larger study of 60 picturebooks about sexual child abuse published over the past 25 years, this paper critically examines eight picturebook representations of the perpetrators of sexual child abuse as a way to understand how potentially dangerous adults are explained to the young readers of these texts.     

Child abuse before Kempe: an historical literature review

This literature review traces the recognition of child abuse and ends where many texts begin with the publication of Henry Kempe's paper in 1962, where the term, "battered child syndrome," was used for the first time. Starting with the first known treatise in pediatrics, the review examines evidence produced throughout the centuries on the recognition of physical child abuse. Many of the references are medical and show how while the early physicians found it easy to accept that those caring for children might injure them, by the end of the 19th century, more obscure diagnoses were being sought to explain the lesions. However, even during the time some physicians were pursuing "scientific" etiologies, there are publications that demonstrate a continuing acknowledgment of the problem of child abuse. No review of this type can claim to be complete, and the author hopes others will be sufficiently interested to seek out further historical references.     

On the interpretation of pictures with and without a content of child sexual abuse.

OBJECTIVE: The purposes of the three experiments were to validate the possibility of a picture to evoke the recognition of child sexual abuse, to determine if the picture was anxiety evoking, and to investigate if the content of child sexual abuse would be transferred to a neutral picture. METHOD: In all three experiments, adult men and women were presented with a drawing intended to depict child sexual abuse, and were requested to interpret the picture. Experiment 1: Before and after the picture presentation, 226 participants were given a test of anxiety. Experiment 2: After the exposure of the child abuse picture, 200 new participants were asked to interpret an innocent child-adult picture. Experiment 3: To complete Experiment 2, 89 new participants were asked to interpret the pictures in the reverse order. RESULTS: Almost three-fourths of the participants saw child sexual abuse in the picture with a sexual threat. Those in Experiment 1 who saw the picture as child sexual abuse or as a problematic child-adult situation without sexual implications reported a significant increase of anxiety level. None in Experiment 2 or 3 saw child sexual abuse in the innocent picture. The sex of the abused child was significantly more often interpreted as opposite to one's own sex. CONCLUSIONS: The study indicates some people's deficient capacity to recognize the message of child sexual abuse in the picture. It seems that certain people can spare themselves anxiety by not registering the child's precarious situation or not seeing the child as being of their own sex. This has implications for the recognition of child sexual abuse in society. It was also shown that a sexual abuse theme was not transferred from one context to another context, which immediately followed it.     

The sexual nature of sexual abuse. A review of the literature

The growing literature on sexual abuse within the family is reviewed within the context of a simple model which emphasises the role of sexual factors and de-emphasises some of the more "dynamic" factors which many other authors have stressed. Evidence from a number of studies is quoted and found to support the view that fathers engaging in sexual activity with their daughters often have unfulfilled sexual needs. They often find the child or children sexually attractive and use a variety of strategies both to deal with their own inhibitions against sexual involvement with the child and to overcome the child's own potential resistance. Furthermore, these parents often find themselves in situations which provide a special opportunity for undetected abuse and they also strive to arrange such circumstances. A view of sexual abuse as primarily fulfilling sexual needs could well lead to a significant change in the management of cases in which sexual abuse has already occurred or is seen as likely to occur.     

Sexual abuse in the national incidence study of child abuse and neglect: An appraisal

The National Incidence Study of Child Abuse and Neglect was a major, government sponsored effort to collect data on reported and unreported child abuse. It used a systematic representative sample methodology and very precisely developed definitions of child abuse. This paper reviews some of the main limitations of the study in regard to findings on sexual abuse. First, there is probably less “new” data in the study on sexual abuse than on other forms of abuse, since so many of the study cases of sexual abuse were “officially reported” cases. In addition, the study limited its definition of sexual abuse only to cases where a caretaker was the perpetrator, a definition that is much more restrictive than what is used in many treatment programs. Finally, the data on perpetrators has a number of problems that stem from the study's definitions of sexual abuse. The paper makes suggestions for future incidence type studies of sexual abuse.     

Removing the child--prosecuting the offender in cases of sexual abuse: evidence from the national reporting system for child abuse and neglect

Sexual abuse has come to public attention so rapidly and is such a difficult problem to deal with that many observers are concerned that the quality of child protective intervention in these cases has been haphazard and indiscriminate. This article analyzes data on all 6,096 cases of child sexual abuse which were "officially reported" in 1978 to see what kinds of intervention were made. The data show that foster placement occurred in more cases of sexual abuse than physical abuse, and was concentrated among cases of older children who reported their own victimization. Criminal action was taken almost five times more often in cases of sexual abuse than in cases of physical abuse, and occurred more often among cases which were directly reported to police and involved offenders with prior criminal records. Black families and poorer families did not seem to be the objects of obvious discrimination in the disposition of these cases.     

Child abuse fatalities and cases of extreme concern: lessons from reviews

OBJECTIVE: The study was commissioned by the Welsh Office to pull together lessons from all reports on cases involving either a child abuse fatality or serious child protection concern ("Part 8 Reviews") since the introduction of the Children Act 1989. METHOD: Twenty-one such reports were identified and subjected to a content analysis to extract practice issues. RESULTS: From 19 reports (excluding Reviews concerning adult sexual abusers), the authors identify seven practice themes emerging from that analysis which are related to those identified in previous studies and to six previously undertaken British overviews of child abuse fatalities. The themes are assessment, interagency communications, responsibility, number of professionals involved, role of general practitioners, insufficient training for pediatricians/radiologists, and parental choice. CONCLUSIONS: British child protection agencies are attempting to address apparently conflicting policy objectives. On the one hand they are required to ensure the protection of the most vulnerable children within the child protection system. At the same time they are also being encouraged to adopt a "lighter touch" in child protection work. The authors conclude that the seven themes may provide some indicators as to how these conflicting objectives may be reconciled.     

Intervening in severe physical child abuse cases: mental health, legal, and social services.

OBJECTIVE: To examine the child protection process in cases of severe physical abuse, to compare characteristics of the families with risk factors previously reported in the published literature, and to develop recommendations about the use of mental health professionals in such cases. METHOD: Reviewers examined 30 case records of severely physically abused children under age 5, nominated by child protection workers and mental health providers. The reviewers recorded demographic, clinical, and case process information such as mental health and other referrals, reunification status, and frequency of criminal prosecution. A case study was described. RESULTS: The parents displayed a range of psychological characteristics (e.g., depression, anxiety, personality disorders) and life problems (e.g., domestic violence, substance abuse, abused as child). The majority of parents denied the abuse. The children were very young (more than half under 6 months old) and many had difficult births or medical problems prior to the abuse. The most common services offered were individual psychotherapy and parenting classes. More than half of the children reunified with at least one parent within I year. Forty percent of the cases involved criminal prosecution. CONCLUSIONS: Reunification occurred more quickly and more often than expected based on the severity of the injuries. The system often relies on psychotherapy to correct the abusive behavior, even when the perpetrator remains unknown and specific risks such as substance abuse or domestic violence are present. The authors advise utilizing multidisciplinary teams for recommendations regarding reunification.     

Analysis of sexual abuse hotline reports

As concern about physical child abuse and neglect has increased, so too has the realization that children are also sexually exploited and abused. Yet, many protective service workers are often ill prepared to perform the difficult task of treating the abused child and his/her family. Through the analysis of sexual abuse hotline reports, the central aim of this study was to generate findings that would increase the knowledge base of protective service workers and private therapists engaged in treating sexually abused children and their families. To accomplish this task, and using seven classes of variables, analysis was performed on 205 substantiated cases of childhood sexual abuse. A number of important conclusions were discovered including: One-third of the cases had been reported to the agency previously; less than one-half (48%) of the victimized children were living with their natural fathers; natural fathers were identified as the perpetrator in 39% of the cases; and in contrast to other studies, a great number of cases (43%) involved vaginal intercourse between the victim and the perpetrator. Implications for treatment are also discussed, particularly in relation to improving resources and specialized training for workers involved in this highly sensitive area of practice.     

Erroneous concerns about child sexual abuse

AIM: To assess the incidence and nature of concerns about sexual abuse, with particular reference to erroneous concerns of sexual abuse made by children. METHODS: A review of case notes of all child sexual abuse reports to the Denver Department of Social Services over 12 months. Cases were put into four groups: substantiated, not sexual abuse, inconclusive and erroneous accounts by children. RESULTS: 551 cases were reviewed. Forty-three percent were substantiated, 21% were inconclusive and 34% were not considered to be abuse cases. There were 14 (2.5%) erroneous concerns emanating from children. They comprised three cases of allegations made in collusion with a parent, three cases where an innocent event was misinterpreted as sexual abuse and eight cases (1.5%) of false allegations of sexual abuse.CONCLUSION: Erroneous concern of sexual abuse from children are uncommon. The four categories of concern in this study, in contrast to the simple classification of substantiated and unsubstantiated, provide a means of encouraging open minded assessments of the typical concerns which a child protection agency receives.     

Child sexual and physical abuse among college students in Singapore and the United States

OBJECTIVES: The purpose of this study was to explore differences in rates and characteristics of child sexual and physical abuse experiences among women in Singapore and the US. METHOD: Participants (N=153) completed an anonymous questionnaire which assessed experiences of childhood sexual and physical abuse, abuse characteristics (e.g., victimization age, severity), and behavioral and subjective reactions to such experiences (e.g., labeling of experiences as abuse, psychological symptomatology). Exposure to other forms of traumatic life events was also assessed. RESULTS: In comparison to Singaporean women, US women were more likely to report a history of child sexual abuse, and to report experiencing more severe forms of sexual abuse. Women in Singapore were more likely than women in the US to report a history of child physical abuse, to report experiencing injury as a result of the abuse, and to disclose the abuse. Singaporean women with a history of child sexual abuse reported elevated psychological symptom levels relative to their nonabused peers and to US women with a history of child sexual abuse, even after controlling for exposure to other types of traumatic events. No significant differences in symptomatology with regard to child physical abuse were observed. CONCLUSIONS: Although preliminary in nature, the present findings are among the first to demonstrate differences in psychological adjustment between sexually abused and nonabused Asian women living in Asia. This study also provides some of the first support for cross-national differences in the psychological adjustment of child sexual abuse survivors.     

Child sexual abuse in Tanzania and Kenya

OBJECTIVE: Most research on child abuse in Tanzania and Kenya is unpublished in the international literature. The purpose of this paper is to examine the various commentaries and reports extant, toward an overview of the nature and frequency of child sexual abuse in Tanzania and Kenya. METHODS: Contacts were made with academics, government departments, NGOs, and UN agencies. This was followed by a field trip in the summer of 2001 where all available reports were examined and a wide range of interviews conducted. RESULTS: Little empirical data exist on child sexual abuse in Tanzania. It is widely perceived that it may be increasing as a result of AIDS sufferers' attempts to "cleanse" themselves. The breakdown of traditional childcare systems, foreign influences, poverty, and the lowly position of girls in society are also implicated. More research has been conducted in Kenya. It is clear that first coitus occurs at a young age for many Kenyan children and adolescents. Also, a degree of force, trickery, or material exchange is not uncommon in adolescent sexual relations. CONCLUSIONS: Child sexual abuse is under-researched in Tanzania and Kenya. Studies by UN agencies such as United Nations Children's Fund (UNICEF) and the International Labour Organisation (ILO) have focused on the commercial sexual exploitation of children, to the neglect of more pervasive abuse in children's own communities by family, relatives, and neighbors. Nationwide surveys of the general population are required for an empirical understanding of this topic. Given the high incidence of AIDS/HIV in both countries, it is important to know if the epidemic is increasing the risk of rape or incest for children.     

Childhood physical and sexual abuse as risk factors for heavy drinking among African-American women: a prospective study

OBJECTIVE: This study examines the associations among characteristics of child sexual abuse. childhood physical abuse, lack of parental care, and heavy drinking in a relatively young, urban population of African-American women all of whom have documented histories of child sexual abuse. METHODOLOGY: The sample consists of 113 African American child victims who were brought to a city hospital emergency room for treatment and collection of forensic evidence in the 1970s and re-interviewed as adults in the 1990s. RESULTS: The results of this research suggest that multiple incidents of child sexual abuse, more than the characteristics of such abuse is an important predictor of adult heavy alcohol use and binge drinking. These results remain even after controlling for the effects of parental drinking behavior. CONCLUSION: Although the victim of multiple child sexual assaults is more likely to suffer force and penetration, these analyses suggest that it is the multiple victimization and not the force or penetration that drives the relationship between child sexual assault and drinking behaviors.     

The Lamaze Certified Childbirth Educator’s Role in Teaching Survivors of Childhood Sexual Abuse

There is a strong likelihood that at least one participant in any Lamaze childbirth education class has had personal experience with childhood sexual abuse. Using the wisdom of Lamaze Certified Childbirth Educators and respected authors in the field of childhood sexual abuse, this column enlightens the childbirth educator in three ways: understanding the incidence of female and male childhood sexual abuse; understanding the effects of sexual, emotional, physical, and verbal abuse on the pregnant and parenting family; and facilitating classes that are sensitive to the needs of survivors of childhood sexual abuse as well to all expectant parents.     

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.     

National call to action: Working toward the elimination of child maltreatment. The economics

No reliable estimates exist of the overall costs to society of child maltreatment that will withstand serious examination. Arguably some of the most important human costs of maltreatment are unquantifiable. Moreover, in many cases it is difficult if not impossible to separate the economics of child abuse and neglect from the economics of a host of other problems facing families. Still, even conservative estimates of government spending on behalf of abused and neglected children and their families illustrate that child maltreatment costs society a great deal, with much of that expense going for deep-end intervention rather than family support and prevention. Government expenditures directed at this social problem have grown rapidly since the rediscovery of child abuse in the 1960s and now exceed spending for a number of essential supports for children and families. Moreover, the new era of continuing commitment to child protection in the context of a revised social contract with the nation's poor raises serious questions about the economics of child maltreatment in the future.