Understanding the Many Faces of Child Neglect: A Review of Denial of Critical Care Cases in Iowa, 2005

In recent years, Iowa leaders and the general public have focused on the abuse children have suffered from several causes, including sexual abuse, methamphetamine manufacturing, and serious physical injury. While this public attention and concern is welcome, the harm that children suffer from neglect, which Iowa law calls denial of critical care, has received little attention, despite representing almost three-quarters of all child abuse cases. With financial assistance from the Greater Des Moines Community Foundation in 2003-2004, Prevent Child Abuse Iowa started a Child Neglect Awareness Project, with the goal of creating greater understanding and awareness of child neglect in Iowa.

The international epidemiology of child sexual abuse: a continuation of Finkelhor

Objective: The purpose of this paper was to compare the prevalence rates of child sexual abuse reported by [Finkelhor, D. (1994). The international epidemiology of child sexual abuse. Child Abuse & Neglect, 18 (5), 409-417] with those found in recent publications in order to confirm the widespread prevalence of child sexual abuse. Methods: Relevant articles about prevalence of child sexual abuse were identified through searches of computerized databases and a handsearch of Child Abuse & Neglect and the Journal of Child Sexual Abuse. Results: Thirty-eight independent articles were identified, corresponding to 39 prevalence studies; these articles report the prevalence of childhood sexual abuse in 21 different countries, ranging from 0 to 53% for women and 0 to 60% for men. Conclusions: Comparison of the present study with that of [Finkelhor, D. (1994). The international epidemiology of child sexual abuse. Child Abuse & Neglect, 18 (5), 409-417] shows a similarity between prevalence distributions; there appears to be a general pattern that remains more or less constant over the years, especially in women. Practice implications: Twelve years after the first revision study about the international prevalence of child sexual abuse, there is still a need for new data about this topic. The present study shows child sexual abuse is still a widespread problem in the society. In this research, carried out on 38 independent studies, there is new data for 21 countries over the world, being especially relevant the results obtained from other countries different from those pertaining toNorth America or Europe. It is important to point out the high prevalence found in most of the countries, so this information could be a new warning to make society and governments aware of this problem and undertake actions to prevent sexual abuse in childhood.

The international epidemiology of child sexual abuse: a continuation of Finkelhor

Objective: The purpose of this paper was to compare the prevalence rates of child sexual abuse reported by [Finkelhor, D. (1994). The international epidemiology of child sexual abuse. Child Abuse & Neglect, 18 (5), 409-417] with those found in recent publications in order to confirm the widespread prevalence of child sexual abuse. Methods: Relevant articles about prevalence of child sexual abuse were identified through searches of computerized databases and a handsearch of Child Abuse & Neglect and the Journal of Child Sexual Abuse. Results: Thirty-eight independent articles were identified, corresponding to 39 prevalence studies; these articles report the prevalence of childhood sexual abuse in 21 different countries, ranging from 0 to 53% for women and 0 to 60% for men. Conclusions: Comparison of the present study with that of [Finkelhor, D. (1994). The international epidemiology of child sexual abuse. Child Abuse & Neglect, 18 (5), 409-417] shows a similarity between prevalence distributions; there appears to be a general pattern that remains more or less constant over the years, especially in women. Practice implications: Twelve years after the first revision study about the international prevalence of child sexual abuse, there is still a need for new data about this topic. The present study shows child sexual abuse is still a widespread problem in the society. In this research, carried out on 38 independent studies, there is new data for 21 countries over the world, being especially relevant the results obtained from other countries different from those pertaining toNorth America or Europe. It is important to point out the high prevalence found in most of the countries, so this information could be a new warning to make society and governments aware of this problem and undertake actions to prevent sexual abuse in childhood.

Expertise and decision making among clinicians in investigations of alleged child sexual abuse

The purpose of the present thesis was to explore different aspects of decision making and expertise in investigations of child sexual abuse (CSA) and subsequently shed some light on the reasons for shortcomings in the investigation processes. Clinicians’ subjective attitudes as well as scientifically based knowledge concerning CSA, CSA investigation and interviewing were explored. Furthermore the clinicians’ own view on their expertise and what enhances this expertise was investigated. Also, the effects of scientific knowledge, experience and attitudes on the decision making in a case of CSA were explored. Finally, the effects of different kinds of feedback as well as experience on the ability to evaluate CSA in the light of children’s behavior and base rates were investigated. Both explorative and experimental methods were used. The purpose of Study I was to investigate whether clinicians investigating child sexual abuse (CSA) rely more on scientific knowledge or on clinical experience when evaluating their own expertise. Another goal was to check what kind of beliefs the clinicians held. The connections between these different factors were investigated. A questionnaire covering items concerning demographic data, experience, knowledge about CSA, selfevaluated expertise and beliefs about CSA was given to social workers, child psychiatrists and psychologists working with children. The results showed that the clinicians relied more on their clinical experience than on scientific knowledge when evaluating their expertise as investigators of CSA. Furthermore, social workers possessed stronger attitudes in favor of children than the other groups, while child psychiatrists had more negative attitudes towards the criminal justice system. Male participants held less strong beliefs than female participants. The findings indicate that the education of CSA investigators should focus more on theoretical knowledge and decision making processes as well as the role of beliefs In Study II school and family counseling psychologists completed a Child Sexual Abuse Attitude and Belief Scale. Four CSA related attitude and belief subscales were identified: 1. The Disclosure subscale reflecting favoring a disclosure at any cost, 2. The Pro-Child subscale reflecting unconditional belief in children's reports, 3. The Intuition subscale reflecting favoring an intuitive approach to CSA investigations, and 4. The Anti Criminal Justice System subscale reflecting negative attitudes towards the legal system. Beliefs that were erroneous according to empirical research were analyzed separately. The results suggest that some psychologists hold extreme attitudes and many erroneous beliefs related to CSA. Some misconceptions are common. Female participants tended to hold stronger attitudes than male participants. The more training in interviewing children the participants have, the more erroneous beliefs and stronger attitudes they hold. Experience did not affect attitudes and beliefs. In Study III mental health professionals’ sensitivity to suggestive interviewing in CSA cases was explored. Furthermore, the effects of attitudes and beliefs related to CSA and experience with CSA investigations on the sensitivity to suggestive influences in the interview were investigated. Also, the effect of base rate estimates of CSA on decisions was examined. A questionnaire covering items concerning demographic data, different aspects of clinical experience, self-evaluated expertise, beliefs and knowledge about CSA and a set of ambiguous material based on real trial documents concerning an alleged CSA case was given to child mental health professionals. The experiment was based on a 2 x 2 x 2 x 2 (leading questions: yes vs no) x (stereotype induction: yes vs no) x (emotional tone: pressure to respond vs no pressure to respond) x (threats and rewards: yes vs no) between-subjects factorial design, in which the suggestiveness of the methods with which the responses of the child were obtained were varied. There was an additional condition in which the material did not contain any interview transcripts. The results showed that clinicians are sensitive only to the presence of leading questions but not to the presence of other suggestive techniques. Furthermore, the clinicians were not sensitive to the possibility that suggestive techniques could have been used when no interview transcripts had been included in the trial material. Experience had an effect on the sensitivity of the clinicians only regarding leading questions. Strong beliefs related to CSA lessened the sensitivity to leading questions. Those showing strong beliefs on the belief scales used in this study were even more prone to prosecute than other participants when other suggestive influences than leading questions were present. Controversy exists regarding effects of experience and feedback on clinical decision making. In Study IV the impact of the number of handled cases and of feedback on the decisions in cases of alleged CSA was investigated. One-hundred vignettes describing cases of suspected CSA were given to students with no experience with investigating CSA. The vignettes were based on statistical data about symptoms and prevalence of CSA. According to the theoretical likelihood of CSA the children described were categorized as abused or not abused. The participants were asked to decide whether abuse had occurred. They were divided into 4 groups: one received feedback on whether their decision was right or wrong, one received information about cognitive processes involved in decision making, one received both, and one did not receive feedback at all. The results showed that participants who received feedback on their performance made more correct positive decisions and participants who got information about decision making processes made more correct negative decisions. Feedback and information combined decreased the number of correct positive decisions but increased the number of correct negative decisions. The number of read cases had in itself a positive effect on correct positive decision.

The Quality of Spousal Social Support as a Moderator of the Associations Between Child Maltreatment Severity and Adult Trauma Symptoms

Child maltreatment has been linked to a myriad of long-term difficulties, including trauma symptomatology. However, not all victims experience long-term distress. Thus, a burgeoning area of research focuses on factors that may impede or facilitate resiliency to the psychological correlates of child maltreatment. Specifically, the severity of the abusive acts may be associated with greater long-term difficulties. To date, however, with the exception of child sexual abuse, few studies have examined the severity of maltreatment as a risk factor in the development of trauma symptoms. In contrast, social support has been theorized to contribute to resiliency following abuse. However, to date, the majority of studies examining positive social support as a protective factor have relied on self-report measures of perceived social support, rather than observational measures of received social support. Moreover, no study to date has examined the role that negative social support (i.e, blaming, criticizing) may play in potentiating trauma symptoms among victims of child maltreatment. Because child maltreatment involves serious boundary violations by a trusted person, a marital relationship is an important domain in which to examine these constructs. That is, it may serve as an arena for the manifestation of psychological disturbances related to maltreatment. Thus, the present study examined whether observationally measured positive and negative spousal social support moderated the relationship between child maltreatment severity (i.e., sexual, physical, psychological abuse; neglect) and trauma symptomatology in women and men. Results indicated that the severity of each type of child maltreatment significantly predicted increased adult trauma symptomatology. Contrary to hypothesized outcomes, positive spousal social support did not predict decreased trauma symptomatology. However, negative spousal social support generally did predict increased trauma symptomatology. There were no consistent patterns of interactions between child maltreatment severity and either type of social support. Future directions for research will be discussed and clinical implications with regard to the intrapersonal and interpersonal functioning of child maltreatment victims will be highlighted.

Rape protocol and child interview techniques : a basic guide for professionals who deal with adult and child victims of sexual abuse.

Jointly funded by ILEC Grant no. 2437 & 2915 and the Chicago Community Trust.

An Exploratory Qualitative Research Study on Resilience and Healing for Asian, Pacific Islander & South Asian Adult Survivors of Child Sexual Abuse

Thesis (Master's)--University of Washington, 2016-06

Blame Attributions Among Child Sexual Abuse Survivors and Disclosure of the Abuse

Child sexual abuse (CSA) disclosure is critical for survivor´s psychosocial adjustment later in life. The aim of the present study was to analyze the relationship between attributions of blame for child sexual abuse by the victim and the disclosure of the abuse to parents or caregivers while controlling for characteristics of the abuse. Female college students between 17 and 24 years of age (M = 19.44, SD = 1.64) from a southern Spanish University were surveyed. Of 1547 respondents, 153 (9.90%) reported having suffered some form of CSA before the age of 15. Information about the characteristics of abuse (age of onset, type of abuse suffered, continuity of abuse, and relationship with and age of the perpetrator) and the existence of abuse disclosure by the survivor was obtained from a self-reported questionnaire developed for the present study. The Attributions of Responsibility and Blame Scale (McMillen & Zuravin, 1997) was used to assess attributions made about CSA (self-blame, perpetrator blame and family blame). The results of a logistic regression model was statistically significant, χ² (9) = 43.856, p < .001. The model explained 41% (Nagelkerke R²) of the variance of abuse disclosure and correctly classified 85.6% of cases. Survivor disclosure was 5.50 times more likely to occur when the perpetrator was not a family member (Wald = 8.14, p < .01) and 3.95 times more likely to occur when there was not physical contact with the perpetrator (Wald = 4.30, p < .05). The occurrence of disclosure was also related to increased perpetrator age (Wald = 4.83, p < .05). With regard to the attributions of blame, the occurrence of disclosure was related to lower scores on self-blame (Wald = 6.78, p < .01) and higher scores on family blame (Wald = 9.67, p < .001). However, no relationship was found between perpetrator blame and disclosure of abuse. The results confirm the idea that not only self-blame attributions, but also family blame attributions are critical to the decision of a CSA victim to disclose abuse. The possibility that children who do not disclose abuse have a greater need to deny the occurrence of abuse, or have more confusion about being abused is discussed. Attributions of blame should be taken into serious consideration when evaluating children for possible sexual abuse.

Childhood adversities and adult psychopathology in the WHO World Mental Health Surveys

Background Although significant associations of childhood adversities with adult mental disorders are widely documented, most studies focus on single childhood adversities predicting single disorders. Aims To examine joint associations of 12 childhood adversities with first onset of 20 DSM-IV disorders in World Mental Health (WMH) Surveys in 21 countries. Method Nationally or regionally representative surveys of 51 945 adults assessed childhood adversities and lifetime DSM-IV disorders with the WHO Composite International Diagnostic Interview (CIDI). Results Childhood adversities were highly prevalent and interrelated. Childhood adversities associated with maladaptive family functioning (e.g. parental mental illness, child abuse, neglect) were the strongest predictors of disorders. Co-occurring childhood adversities associated with maladaptive family functioning had significant subadditive predictive associations and little specificity across disorders. Childhood adversities account for 29.8% of all disorders across countries. Conclusions Childhood adversities have strong associations with all classes of disorders at all life-course stages in all groups of WMH countries. Long-term associations imply the existence of as-yet undetermined mediators.

Sexueller Missbrauch bei Kindern und Jugendlichen- Aufdeckung, Untersuchung und Erstbetreuung [Sexual abuse of female children and adolescents--detection, examination and primary care].

Epidemiological studies show a prevalence of sexual abuse experience among girls from 14-33%. Although indicators of abuse are unspecific, the combination of several findings may be indicative: Somatic signs may be sexually transmitted diseases, vulvovaginal complaints. Psychosocial nonsexual indicators are abrupt behavioural changes, running away from home, eating disorders. Psychosexual signs are hypersexualisation of the language and behaviour, disturbed body image and gender identity. Indirect evidence of abuse is given not only in cases of old vaginal and anal lesions but also in situations, where deep tears of the hymen in the typical localization at the posterior part can be found. The workup and care for children in whom there is suspicion of abuse but no clear evidence asks for highly competent professionals in a multidisciplinary cooperation including pediatric gynecologists, child psychiatrists, children-protection groups and other specialists to avoid on one hand unjustified destabilisation or even destruction of familial structures but to assure on the other hand, that the child victims are treated and followed after in a short and long term comprehensive medical and psychosocial care.

Title IV-B Child and Family Service Plan 2010 Annual Progress and Service Report, June 2010

In June 2009, the Iowa Department of Human Service (IDHS) developed a Child and Family Service Plan (CFSP) that sets forth the Department’s vision and goals to be accomplished for FYs 2010 through 2014. The purpose of the CFSP is to strengthen the States’ overall child welfare system and to facilitate the state’s integration of the programs that serve children and families into a comprehensive and continuum array of child welfare services from prevention and protection through permanency. These programs include title IV-B, subparts 1 and 2 of the Act, the Child Abuse Prevention and Treatment Act (CAPTA), the Chafee Foster Care Independence Program (CFCIP), and the Education and Training Vouchers (ETV) programs for older and/or former foster care youth. IDHS administers the IV-B, CAPTA, CFCIP and the ETV programs described within Iowa’s CFSP. Iowa’s Annual Progress and Services Report (APSR) provides an annual update on the progress made toward accomplishing the goals and objectives identified in the state’s CFSP for the previous fiscal year (2009-2010) and the planned activities for next fiscal year (2010-2011) .

Type I osteogenesis imperfecta and multiple osteochondromas in the same child.

A male infant showed a humeral diaphysis fracture at 5 months of age and a distal tibial physis fracture at 2 years of age. A specialized consultant ruled out child abuse. This child had the characteristic features of type I osteogenesis imperfecta: blue sclerae, osseous fragility, and presumably autosomal dominant inheritance, as his father suffered from similar disorders. Later on, multiple painful osteochondromas were also found and some of these were surgically treated. The child's mother showed several peripheral osteochondromas. We describe the follow-up of this patient up to the age of 18 years. To our knowledge, the fortuitous association of these two inherited conditions has not been reported in medical literature.

Disclosure of Child Sexual Abuse : Impact of Interviewers’ Attitudes & Children's Collaboration during Forensic Interviews

L’agression sexuelle (AS) commise envers les enfants est un sujet complexe à enquêter et les allégations reposent souvent exclusivement sur le témoignage de l’enfant. Cependant, même quand l’enfant divulgue une AS, il peut être réticent à révéler certains détails personnels et gênants de l’AS à un étranger. Étant donné qu’il n'est pas toujours possible d'obtenir le consentement de filmer et qu’il est relativement difficile de mesurer l’attitude non verbale de l’enfant et celui de l’enquêteur au cours des entrevues d’investigations, cette recherche a été novatrice dans sa création d’échelles verbales de telles attitudes. Afin de déterminer la corrélation de l’attitude des enquêteurs et la collaboration des enfants, 90 entrevues d’enfants âgés de 4 à 13 ans ont été analysées. Les entrevues ont été enregistrées sur bande audio, transcrites et codifiées à l'aide des sous-échelles verbales d'attitudes soutenantes et non-soutenantes des enquêteurs ainsi que d’attitudes de résistance et de coopération de la part de l'enfant. La proportion des détails sur l’AS fournie par les enfants a également été calculée. Afin de comparer les entrevues avec et sans le protocole du National Institute of Child Health and Human Development (NICHD), une MANCOVA, contrôlant pour l’âge de l’enfant et la proportion de questions ouvertes, démontre tel qu’attendu que les entrevues avec le protocole obtiennent plus de détails fournis à la suite des questions ouvertes que les entrevues sans le protocole. Cependant, aucune différence ne ressort quant aux attitudes de l’enfant et celle de l’enquêteur. Afin de trouver le meilleur prédicteur de la quantité de détails dévoilés par les enfants, une analyse de régression multiple hiérarchique a été faite. Après avoir contrôlé pour l'âge de l’enfant, l’utilisation du protocole et la proportion de questions ouvertes, la résistance de l’enfant et l’attitude non-soutenante de l’enquêteur expliquent 28 % supplémentaire de la variance, tandis que la variance totale expliquée par le modèle est de 58%. De plus, afin de déterminer si la collaboration de l’enfant et l’attitude de l’enquêteur varient en fonction de l’âge des enfants, une MANOVA démontre que les enquêteurs se comportent similairement, quel que soit l'âge des enfants. Ceci, malgré le fait que les jeunes enfants sont généralement plus réticents et coopèrent significativement moins bien que les préadolescents. Finalement, une régression multiple hiérarchique démontre que le soutien de l'enquêteur est le meilleur prédicteur de la collaboration des enfants, au-delà des caractéristiques de l'enfant et de l’AS. Bien que l’utilisation du protocole NICHD ait permis des progrès considérables dans la manière d’interroger les enfants, augmentant la proportion de détails obtenus par des questions ouvertes/rappel libre et amplifiant la crédibilité du témoignage, l’adhésion au protocole n’est pas en soi suffisante pour convaincre des jeunes enfants de parler en détail d’une AS à un inconnu. Les résultats de cette thèse ont une valeur scientifique et contribuent à enrichir les connaissances théoriques sur les attitudes de l'enfant et de l'enquêteur exprimées lors des entrevues. Même si les enquêteurs de cette étude offrent plus de soutien aux enfants résistants, indépendamment de leur âge, pour promouvoir la divulgation détaillée de l’AS, de meilleures façons de contrer les attitudes de résistance exprimées par les jeunes enfants et une minimisation des attitudes non-soutenantes lors des entrevues sont nécessaires.

Sexual abuse in childhood and postoperative depression in women with breast cancer who opt for immediate reconstruction after mastectomy

INTRODUCTION Breast reconstruction is routinely offered to women who undergo mastectomy for breast cancer. However, patient-reported outcomes are mixed. Child abuse has enduring effects on adults’ well-being and body image. As part of a study into damaging effects of abuse on adjustment to breast cancer, we examined: (i) whether women with history of abuse would be more likely than other women to opt for reconstruction; and (ii) whether mood problems in women opting for reconstruction can be explained by greater prevalence of abuse. PATIENTS AND METHODS We recruited 355 women within 2-4 days after surgery for primary breast cancer; 104 had mastectomy alone and 29 opted for reconstruction. Using standardised questionnaires, women self-reported emotional distress and recollections of childhood sexual abuse. Self-report of distress was repeated 12 months later. RESULTS Women who had reconstruction were younger than those who did not. Controlling for this, they reported greater prevalence of abuse and more distress than those having mastectomy alone. They were also more depressed postoperatively, and this effect remained significant after controlling for abuse. CONCLUSIONS One interpretation of these findings is that history of abuse influences women's decisions about responding to the threat of mastectomy, but it is premature to draw inferences for practice until the findings are replicated. If they are replicated, it will be important to recognise increased vulnerability of some patients who choose reconstruction. Studying the characteristics and needs of women who opt for immediate reconstruction and examining the implications for women's adjustment should be a priority for research.