Accusations that hospital staff have abused pediatric patients

OBJECTIVE: Study objectives were to describe a hospital Child Protection Team's (CPT) efforts to develop and implement a protocol for systematic evaluation and management of accusations that hospital staff have abused pediatric patients, and to learn how to avoid problematic patient encounters and cope with existing accusations. METHOD: This study reports on a retrospective series of cases from one pediatric hospital between 1982 and 1996. It includes a survey of national children's hospitals' experience from 1990 through 1995. RESULTS: After initial complaints to our hospital's CPT, it became apparent that procedures were inadequate to protect the safety of patients and rights of the accused. A protocol for reporting, evaluation, and management of accusations was developed and implemented by the CPT. Thirty-four accusations of abuse of children by staff were reviewed. Seventeen of the physical abuse cases included bruising, fractures, rough handling, and verbal abuse. Eighteen sexual abuse complaints included touching and sexual statements. Complaints were substantiated in 23% of the accusations, and a third of the identified staff members were fired or resigned. Child victims had a high frequency of chronic illness. They and their families frequently had histories of prior abuse, mental illness, and social disarray. These factors made children more likely to become victims of real abuse and to misinterpret standard hospital procedures as abusive. All service areas of the hospital and types of hospital staff were accused of patient abuse. CONCLUSIONS: Few children's hospitals have formal protocols for internal management of or training programs to avoid complaints. Institutions and their staff who care for children should anticipate abuse complaints, train them in risk reduction methods, and develop accusation management plans.     

Child and adolescent abuse and subsequent victimization: a prospective study

OBJECTIVE: We investigated the possible reciprocal relationship between victimization experiences and psychological functioning by assessing abuse experiences in childhood, adolescence, and during a 2-month follow-up period. METHOD: At the beginning of the study (Time 1), abuse histories, trauma and depressive symptoms, and interpersonal functioning were assessed in 551 college women. Subsequent victimization experiences and psychological outcomes were assessed at the follow-up (Time 2). RESULTS: Path analyses indicated that verbal abuse by the mother and father were predictive of various psychological outcomes as measured at Time 1 and emerged as the only significant predictors of adolescent dating violence. Adolescent dating violence subsequently predicted the experience of dating violence during the 2-month follow-up period. Paternal physical abuse predicted adolescent sexual victimization which subsequently predicted all symptom measures at Time 1. Conversely, the experience of adolescent physical dating violence was not predictive of any of the symptom measures at Time 1. For those women who experienced dating violence during the follow-up, however, the severity of their abusive experiences was related to both depression and interpersonal problems assessed at Time 2. In comparison, for those women who experienced sexual victimization during the follow-up period, the severity of their abusive experiences was related to trauma symptoms. Interpersonal problems emerged as both an aftereffect of adolescent sexual victimization experience and a predictor of a subsequent sexual victimization experience during the follow-up. CONCLUSIONS: Given that emotional abuse emerged as a predictor of adolescent dating violence and psychological outcomes, researchers and clinicians need to continue to explore this problem. Further, it is important to assess how interpersonal problems contribute to the risk of subsequent sexual victimization and to try to break the cycle between adolescent abuse experiences and subsequent physical and sexual assaults.     

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.     

Screening homeless youth for histories of abuse: prevalence, enduring effects, and interest in treatment

Objectives

To identify the incidence of self-reported physical and sexual child abuse among homeless youth, the self-perceived effects of past abuse, and current interest in treatment for past abuse among homeless youth with histories of abuse.

Methods

Homeless and street-involved persons aged 18-23 filled out a questionnaire and participated in a structured assessment of histories of abuse, tobacco use and substance abuse.

Results

Sixty-four homeless youth in Salt Lake City, Utah completed the study, 43 males and 21 females. Eighty-four percent screened positive for childhood physical and/or sexual abuse occurring before the age of 18; 42% screened positive for both physical and sexual abuse; 72% reported still being affected by their abuse. Among all abuse victims, 44% were interested in treatment for their abuse history and 62% of homeless youth who reported still being affected by their abuse were interested in treatment. Individuals were more likely to be interested in treatment if they were female, had not completed high school or had been previously asked about family dysfunction. Many victims who declined treatment offered spontaneous insight into their decision. Interest in treatment was similar to interest in treatment for other behaviors such as smoking and substance abuse.

Conclusions

Histories of abuse are common among homeless youth. A majority of those reporting a history of abuse are still affected by their abuse. Interest in treatment for a history of abuse was comparable to interest in treatment for other morbidities in the homeless youth population such as tobacco use and substance abuse. Our finding that homeless youth continue to be impacted by their abuse and are interested in treatment should prompt more screening for histories of abuse.     

Epidemiologic variations in childhood sexual abuse

We retrospectively reviewed records of 566 children ranging from 6 months to 16 years of age who presented to a sexual assault crisis center. They represented 33.2% of all alleged sexual assault victims seen over a 36 month period. There were 103 males (18.2%) and 463 females (81.8%). Significant differences in presentation were demonstrated with respect to the victim's age, sex, and race, but the major factor influencing the variation is the victim/assailant relationship. Younger children were more likely than older children to present with histories of multiple assaults (p less than .0005), by known assailants (p less than .0005), occurring in the child's or assailant's home (p less than .001) and to report less violence (p less than .05). More risk of violence (p less than .0005) or evidence of trauma (p less than .0005) and less reporting of home assaults (p less than .0005) or multiple assault episodes (p less than .0005) were found in assaults by strangers when compared with non-stranger assaults. A lower frequency of reporting was found in females between 7 and 11 years of age. The dynamics of childhood sexual abuse are discussed in relationship to these findings. A number of victim and assailant related factors determine reporting patterns of childhood sexual abuse.     

Relationship between child abuse exposure and reported contact with child protection organizations: Results from the Canadian Community Health Survey

Much of what is known about child abuse in Canada has come from reported cases of child abuse and at-risk samples, which likely represent the most severe cases of child abuse in the country. The objective of the current study is to examine the prevalence of a broad range of child abuse experiences (physical abuse, sexual abuse, and exposure to IPV) and investigate how such experiences and sociodemographic variables are related to contact with child protection organizations in Canada using a representative general population sample. Data were drawn from the 2012 Canadian Community Health Survey: Mental Health collected from the 10 provinces using a multistage stratified cluster design (n = 23,395; household response rate = 79.8%; aged 18 years and older). Physical abuse only (16.8%) was the most prevalent child abuse experience reported with the exposure to specific combinations of two or more types of child abuse ranging from 0.4% to 3.7%. Only 7.6% of the adult population with a history of child abuse reported having had contact with child protection organizations. Experiencing all three types of child abuse was associated with the greatest odds of contact with child protection organizations (AOR = 15.8; 95% CI = 10.1 to 24.6). Physical abuse only was associated with one of the lowest odds of contact with child protection organizations. Preventing child abuse is widely acknowledged as an important, but challenging public health goal. Strategies to increase reporting of child abuse may help to protect children and to connect families with necessary services. One obvious priority would be physical abuse.     

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.