The "HEALTH" model- part 1 : treatment program guidelines for complex PTSD

This paper outlines the development and piloting of the “HEALTH” model for treatment of Complex PTSD in clients who have experienced multiple traumas across childhood and adulthood - particularly child sexual abuse and sexual assault in adulthood. As a guideline-based treatment model, HEALTH outlines six stages of intervention: (1) having a supportive therapist; (2) ensuring personal safety; (3) assisting with daily functioning; (4) self-regulation - learning to manage core PTSD symptoms; (5) treating Complex PTSD symptoms; and, finally, (6) having patience and persistence to enable “ego strengthening”. Using a case study approach, we provide both qualitative and quantitative assessment data for the individuals in the study, all of whom displayed numerous pre-treatment symptoms of Complex PTSD. Such programs are different to standard PTSD treatment programs that focus predominantly on core PTSD symptoms of re-experiencing, avoidance and arousal. The results of this study provided support for the use of guideline-based treatment programs that cater specifically for the needs of those who have suffered long-term/multiple trauma experiences by targeting Complex PTSD symptoms.

Colour of walls : incorporating the exegesis "Unfit for publication"

The thesis is presented in two parts: a novel and a theoretical essay. It is a broadly autobiographical work, concerning issues and events surrounding father-daughter rape. It is written from the mother's perspective, and deals with the impact of child sexual assault on the lives of two generations of working-class women.

Shared parenting

The thesis addresses shared parenting, an arrangement which emphasises the equal responsibility of both parents for children after separation, which is often assumed to ameliorate the supposed negative effects of parental separation. This study found that from children's perspective, the most important consideration was not the type of family they lived in but rather the quality of their relationship with each parent that impacted on their emotional adjustment. The portfolio focuses on the challenge of dealing with allegations of child sexual abuse in the context of the Family Court. The comples issues involved in these types of cases are illustrated by four case studies.

What themes trigger investigative interviewers to ask specific questions when interviewing children?

Recent research has established that investigative interviewers have difficulty adhering to openended questions and instead ask specific questions when interviewing children about abuse. The current study aims to examine the themes in abuse-related interviews that trigger investigators to ask specific questions. Twenty police officers who were authorised to conduct investigative interviews with children completed a mock interview with an expert in child abuse interviewing who had been trained to play the role of an abused child. During the interview, the officers were stopped by a researcher and asked to reflect on why they had asked specific questions. Overall, the results revealed five areas where the officers deviated from open-ended questions. These related to: (1) the identity of the alleged offender; (2) the meaning of terms used by the child to describe genitals; (3) whether or not penetration occurred; (4) the offender's intent and motives; and (5) the timing of the abuse and where it occurred. Each of these themes is discussed, along with the implications for trainers and researchers in child abuse interviewing.

Post-traumatic stress disorder and quality of life in sexually abused Australian children

The study used publicly available data on post-traumatic stress disorder in a sample of the Australian population with a history of sexual abuse to demonstrate how this evidence can inform economic analyses. The 2007 Australian Mental Health Survey revealed that 8.3% of 993 adolescents experienced childhood sexual abuse, of which 40.2% were diagnosed with post-traumatic stress disorder. Post-traumatic stress disorder diagnosis corresponded to a significant loss of quality of life. Survival analysis was used to estimate the lifetime persistence of post-traumatic stress disorder symptoms. The average time between post-traumatic stress disorder onset and remission was 11.4 years. Results suggest that successful treatment of post-traumatic stress disorder will save 2.05 quality adjusted life years per child or adolescent with post-traumatic stress disorder.

Multiple forms of child abuse and neglect: adult retrospective reports

There are few research reports of the experience of multiple forms of child abuse and neglect (multi-type maltreatment). A critical review is presented of 29 studies in which adult retrospective reports of more than one form of child maltreatment (sexual abuse, physical abuse, psychological maltreatment, neglect, or witnessing family violence) are assessed. Empirical investigations of the extent and impact of multi-type maltreatment are identified. Data on the relationship between the different forms of maltreatment and the adjustment problems associated with each type of maltreatment are critiqued. As well as using dichotomous measures of maltreatment, an important methodological problem was the failure of researchers to assess all child maltreatment types, the relationship between multi-type maltreatment and adjustment, and the role of variables influencing the occurrence or impact of maltreatment. Considerable overlap was found in the occurrence of maltreatment types. The compounding or interacting effects of experiencing multi-type maltreatment were ignored in many studies. Where an assessment was made of the specific impact of multi-type maltreatment, it was associated with greater impairment than single forms of abuse or neglect. A multi-dimensional approach to prevention and treatment of child abuse and neglect is required in which children's vulnerability to multi-type maltreatment is addressed.

On the relationship between child abuse and eating pathology

The thesis examined variables that could potentially mediate the relationship between child abuse and eating pathology. The relationship was found to be intricate and multi-faceted with important gender differences. The most novel finding was that drive for muscularity was significantly associated with child abuse in males and in females. The portfolio presents four adult case studies, each with different experiences of child abuse. It aims to examine if the core tenets of neurobiological theory of trauma can be useful to understand the lasting effects of child abuse on adult functioning.

Sexual and violent recidivism by offender type and actuarial risk : reoffending rates for rapists, child molesters and mixed-victim offenders

The current study examines sexual and violent reoffence rates for a sample of 2474 sexual offenders over an average of 15 years following release from prison. Reoffence rates are reported as a function of the offenders' victim type and level of risk as assessed by the Automated Sexual Recidivism Scale, a computer scored measure of relevant historical risk factors. Observed sexual recidivism rates for offenders with child victims, adult victims, and mixed victims were quite similar. Results indicate that offenders with exclusively female child victims not only showed a lower rate of sexual reoffending, but that the reoffence rates were relatively low across all levels of actuarial risk. In contrast, those with male child victims and adult victims showed a pronounced escalation of reoffence rates as actuarial risk increased. Results also indicated that adult victim offenders are less consistent in the victim type of their reoffences, with 37% sexually reoffending against child victims. Finally, combined rates of sexual and violent reoffending were particularly high for those with adult victim sexual offence histories. Risk assessment and public policy implications are discussed.

The importance of degree versus type of maltreatment: a cluster analysis of child abuse types

The author conducted secondary data analysis of 3 previously reported studies (D. J. Higgins & M. P McCabe, 1998, 20(K)b, 2(X)3) to examine whether respondents are best classified according to their experience of separate maltreatment types (sexual abuse, physical abuse, psychological maltreatment, neglect, and witnessing family violence) or whether their experience reflects a single unifying concept: child maltreatment.

Specific risk assessment based on victim type in children sexual offenders

Actuarial instruments for assessing sex offender recidivism have limited utility for specific risk assessment questions, such as the risk posed to particular types of victim. In order to obtain variables that discriminate between offenders with different classes of victim, data were coded from 324 files of child sexual offenders from a community-based sexual offender treatment program. Offenders with single or multiple victims were compared, as were offenders who did or did not offend against victims of both genders, and offenders with only intra-familial or extra-familial victims versus offenders with victims in both relationship categories. Variables that discriminated single-victim and multiple-victim offenders were similar to those identified in actuarial risk assessment scales, with the exception of history of childhood sexual abuse. With the exception of physical abuse history, the same variables discriminated specific offender groups according to victim gender and victim relationship, although in different combinations. There was limited support for the notion of specific risk variables.

Victims' perceptions of a new model of sexual assault investigation adopted by Victoria Police

This paper evaluates a method of operation for sexual assault investigation recently developed by Victoria Police (Australia). The model (which is new to Victoria) is characterised by two core components: the establishment of specialist teams of investigators (responsible for investigation and victim support) and service sites referred to as ‘Multidisciplinary Centres’ where all key services are provided to victims in a single location separate from police stations. The approach consisted of in-depth interviews with 25 victims of sexual assault aged between 15 and 54 years. The overriding theme to arise from the interviews was the importance to victims of being treated with dignity and respect; six elements were highlighted by victims as assisting this. These elements are presented along with evidence to demonstrate that the police response to victims has become more victim-centred under the new model of service delivery.

Effects of persisting emotional impact from child abuse and norepinephrine transporter genetic variation on antidepressant efficacy in major depression: a pilot study

OBJECTIVE: Previous studies suggest child abuse and serotonergic polymorphism influence depression susceptibility and antidepressant efficacy. Polymorphisms of the norepinephrine transporter (NET) may also be involved. Research in the area is possibly clouded by under reporting of abuse in researcher trials. METHODS: Adults (n=51) with major depressive disorder has 8 weeks treatment with escitalopram or venlafaxine. Abuse history was obtained, the ongoing emotional impact of which was measured with the 15-item impact of event scale (IES-15). The 17-item Hamilton Depression Rating Scale (HDRS) was applied serially. Two NET polymorphisms (rs2242446 and rs5569) were assayed, blinded to HDRS ratings and abuse history. RESULTS: No subjects reporting abuse with high impact in adulthood (IES-15 ≥26, n=12) remitted; whereas 77% reporting low impact (IES-15 <26; n=26) remitted (p<0.001). Subjects reporting high impact abuse (n=12) had a 50-fold (95% confidence interval=4.85-514.6) greater odds of carrying rs2242446-TT genotype, but the small sample size leaves this finding vulnerable to type I error. CONCLUSIONS: The level of persisting impact of child abuse appears relevant to antidepressant efficacy, with susceptibility to such possibly being influence by NET rs2242446 polymorphism. Larger studies may be merited to expand on this pilot level finding given potential for biomarker utility.

The development of the comprehensive child maltreatment scale

In this paper, data are presented from four studies that describe and evaluate the psychometric properties of the Comprehensive Child Maltreatment Scale (CCMS). This is a new measure that assesses five separate types of maltreatment experienced during childhood (sexual abuse, physical abuse, psychological maltreatment, neglect and witnessing family violence) and the existence of multi-type maltreatment. This scale is the only paper-and-pencil research scale available that assesses all five types of child maltreatment separately. In Studies 1 and 2, the CCMS for Adults was used to assess retrospective reports of adults' own childhood experiences (N=313). The parallel version of the CCMS for Parents was used in Studies 3 and 4 to assess parent reports of the experiences of children from 5 to 12 years of age (N=100). Adequate test-retest reliability and internal consistency were found for each of the scales of the CCMS for Adults and the CCMS for Parents. As well as performing an exploratory factor analysis, a criterion validity check on the CCMS for Adults revealed high correlations with appropriate subscales from the Child Abuse Trauma Scale. These preliminary data on the CCMS for Adults and Parents show that they are psychometrically sound and useful research tools in the study of multiple forms of child abuse and neglect. The CCMS for Adults and the CCMS for Parents allow for a simple yet comprehensive assessment of multi-type maltreatment.

Is domestic violence learned? The contribution of five forms of child maltreatment to men's violence and adjustment

On the basis of a learning-theory approach to the intergenerational transmission of violence, researchers have focused almost exclusively on violent men's childhood experiences of physical abuse and witnessing family violence. Little consideration has been given to the coexistence of other forms of child maltreatment or the role of family dysfunction in contributing to violence. This study shows the relationships between the level of child maltreatment (physical abuse, psychological maltreatment, sexual abuse, neglect, and witnessing family violence), childhood family characteristics, current alcohol abuse, trauma symptomatology, and the level of physical and psychological spouse abuse perpetrated by 36 men with a history of perpetrating domestic violence who had attended counseling. As hypothesized, a high degree of overlap between risk factors was found. Child maltreatment, low family cohesion and adaptability, and alcohol abuse was significantly associated with frequency of physical spouse abuse and trauma symptomatology scores, but not psychological spouse abuse. Rather than physical abuse or witnessing family violence, childhood neglect uniquely predicted the level of physical spouse abuse. Witnessing family violence (but not physical abuse) was found to have a unique association with psychological spouse abuse and trauma symptomatology. These results present a challenge to the understanding of domestic violence obtained from learning theory.