Prevention of Child Sexual Abuse: Analysis and Discussion of the Field

Prevention of child sexual abuse is complicated, challenging, and highly necessary as sexual abuse of children and youth represents an extensive problem across the world. This article reviews the existing preventive interventions targeting children, parents, and professionals. An alternative way of organizing the child sexual abuse prevention research literature is offered and applied with emphasis on three areas: (a) child sexual abuse prevention interventions, (b) meta-analyses of child sexual abuse prevention interventions, and (c) general theoretical models about prevention and the child. Based on an analysis of these areas, it was found that there was a lack of connection between theoretical models and concrete preventive interventions. An overview of current challenges and future possibilities in this area is provided.     

School counsellors' perceptions of mandatory reporter training and mandatory reporting experiences

The purpose of this study was to examine child abuse reporting by a national sample of school counsellors in the United States. The qualitative results from a large mixed methods study incorporating both quantitative and qualitative strands are presented. Participants were asked to comment on past child abuse training, noting the areas of training they found most beneficial and areas where they desired additional training. Participants were also afforded the opportunity to make any general comments regarding their perceptions of the current mandatory reporting legislation and their experiences of reporting child abuse. Results showed that while many school counsellors felt past training on mandatory reporting legislation and identifying types of abuse was helpful, they identified a need for additional training in identifying emotional and sexual abuse, and supervisory neglect (i.e. lack of supervision by a parent or caretaker producing potential injury or harm to the child). They also desired more training regarding working with children and families affected by child abuse. Four themes emerged from the open question. The first theme illuminated concerns regarding the effectiveness of the mandatory reporting process while the second theme was equally negative, with counsellors sharing many frustrations about their working relationship with child protection services. Additional themes related to their reporting experiences and specific challenges embedded in the school context, such as dealing with parents following a report, difficulty getting adolescent reports investigated and working with school personnel to ensure that reporting responsibilities were understood and followed. Copyright. © 2009 John Wiley & Sons, Ltd.     

Prevalence of Sexual Trauma History Using Behaviorally Specific Methods of Assessment in First Year College Students

There are several challenges associated with evaluating the prevalence of sexual trauma, including child sexual abuse and adult sexual assault. The aim of this study was to assess sexual trauma prevalence rates among first year college students (N = 954) using behaviorally specific questions and a more representative recruitment sample that did not rely on self-selection. Participants completed a list of sexual trauma questions, including general questions containing labels such as “rape” or “abuse” as well as behaviorally specific questions that describe specific behaviors that qualify as sexual trauma without labels. Results indicated that 6.7% of the sample reported at least one incident of child sexual abuse, with similar rates for men and women. Women were more likely to report a history of adult sexual assault, which was reported by 12.4% of the total sample. Participants were also more likely to endorse a history of sexual trauma when answering behaviorally specific rather than general “label” questions. Women survivors in particular were more likely than men to identify their experiences as abuse/assault (66.7% versus 21.1% for child sexual abuse), which may help explain prevalence differences between men and women in prior research. Men may be less likely than women to label their experiences as abuse and may be underidentified in sexual trauma research without the use of behaviorally specific questions. Overall, the results of this study suggest that the prevalence of sexual trauma is better assessed using behaviorally specific questions and that this is an important topic of study among both men and women.     

The Association of Maternal Depressive Symptoms with Child Externalizing Problems: The Role of Maternal Support Following Child Sexual Abuse

This study examines the role of abuse-specific maternal support in the association between parent depressive symptoms and child externalizing problems in a sample of children with a history of sexual abuse. In total, 106 mother–child dyads were studied. The association between maternal depressive symptoms and child delinquency behaviors was found to partially operate through abuse-specific maternal support, which was assessed via parent report. Implications of the findings for parenting programs are discussed, and future research directions are considered.     

Contributions of Child Sexual Abuse,Self-Blame,Posttraumatic Stress Symptoms,and Alcohol Use to Women’s Risk for Forcible and Substance-Facilitated Sexual Assault

Child sexual abuse and adult sexual assault have been linked to increased self-blame, posttraumatic stress symptoms, and alcohol use. The current study aims to examine (a) whether these constructs explain women’s risk for later adult sexual assault and revictimization, (b) whether such factors differentially confer risk for specific types of adult sexual assault (i.e., substance-facilitated and forcible), and (c) if self-blame confers risk indirectly through other risk factors. Multiple types of self-blame, posttraumatic stress, and alcohol use were examined among 929 female college students as serial mediators of the relationship between child sexual abuse and adult sexual assault and as risk factors for sexual revictimization among child sexual abuse survivors. In the model predicting risk for substance-facilitated adult sexual assault, child sexual abuse indirectly predicted greater risk for substance-facilitated adult sexual assault mediated through two separate paths: global blame-to-posttraumatic-stress and global blame-to-alcohol use. In the model predicting risk for forcible adult sexual assault, child sexual abuse directly predicted greater risk for forcible adult sexual assault, and this relation was mediated by the global blame-to-posttraumatic-stress path. Among child sexual abuse survivors, child sexual abuse specific characterological and behavioral self-blame directly predicted greater risk for forcible and substance-facilitated revictimization, but the pathways were not mediated by posttraumatic stress or alcohol use. Results emphasize the importance of assessing different types of self-blame in predicting posttraumatic stress symptoms as well as examining risk for sexual victimization and revictimization. Findings did not support hypotheses that increased posttraumatic stress would predict increased alcohol use but did indicate that heightened self-blame is consistently associated with heightened posttraumatic stress and that heightened global self-blame predicts increased alcohol use. Implications for future research and intervention are discussed.     

Partnering with parents to prevent childhood sexual abuse

Although research demonstrates that child‐focused sexual abuse prevention programmes can teach children personal safety knowledge and skills, childhood sexual abuse (CSA) prevention programmes that involve parents have a number of distinct advantages. The more knowledge parents have about CSA, the greater likelihood they can create safer environments for their children and thus prevent the occurrence of sexual exploitation. Research has demonstrated that parents lack crucial information about CSA and can benefit from even brief educational efforts. This paper will identify potential barriers to participation and offer practical suggestions for enhancing both recruitment and retention rates. Recommendations for parent education programmes are offered, including improving parents' confidence and skills in educating their children about CSA, providing them with parent‐friendly materials to use and developing Internet applications. Copyright © 2010 John Wiley & Sons, Ltd.     

Child Sexual Abuse,Post-Traumatic Stress Disorder,and Substance Use: Predictors of Revictimization in Adult Sexual Assault Survivors

This study examined the unique effects of child sexual abuse simultaneously with post-traumatic stress disorder symptom clusters, problem drinking, and illicit drug use in relation to sexual revictimization in a community sample of female adult sexual assault victims. Participants (N?=?555) completed two surveys a year apart. Child sexual abuse predicted more post-traumatic stress disorder symptoms in adult sexual assault victims. Post-traumatic stress disorder numbing symptoms directly predicted revictimization, whereas other post-traumatic stress disorder symptoms (reexperiencing, avoidance, and arousal) were related to problem drinking, which in turn predicted revictimization. Thus, numbing symptoms and problem drinking may be independent risk factors for sexual revictimization in adult sexual assault victims, particularly for women with a history of childhood sexual abuse.     

Parents' knowledge,attitudes and practices about preventing child sexual abuse: a literature review

Increased concern about high rates of child sexual abuse has led to the demand for more prevention programmes, particularly those aimed at parents. Research on how parents manage and reduce the risk of child sexual abuse can help plan programmes. This literature review explores published research on the knowledge, attitudes and practices of parents on the risk and prevention of child sexual abuse and identifies gaps and needs for further research. The majority of studies reviewed originated in North America and Asia, were quantitative, surveyed mainly mothers and were more than ten years old. Recommendations are made for more current and country specific research, further research to gain a deeper understanding of how parents manage the risk of child sexual abuse, more comprehensive research covering a range of knowledge, attitude and practice variables, and greater inclusion of fathers in research. Copyright © 2009 John Wiley & Sons, Ltd.     

The Relationship between Knowledge and Child and Caregiver Distress during the Medical Examination for Child Sexual Abuse

When child sexual abuse is suspected, a child sexual abuse–related medical examination is recommended to ensure the child's well-being. While the extant research has sought to identify factors influencing child distress during this examination, only recently have studies began examining variables that may be directly associated with the child or with the medical setting. Knowledge of the child sexual abuse–related medical examination is one medical-related variable that has been implicated in child and caregiver distress during the examination. The current study contributes to the existing literature by investigating associations among examination knowledge in relation to caregiver and child anxiety at the time of a child sexual abuse–related medical examination, taking into account ethnicity, past child abuse, injury to child as result of abuse, and caregiver response to disclosure. Sixty-eight children and their nonoffending caregiver were assessed. Results indicated that understanding of the examination and caregiver response to disclosure were significantly associated with caregiver and child anxiety.     

Reporting Child Sexual Abuse within Religious Settings: Challenges and Future Directions

The sexual abuse of children within religious settings is an issue that has gained increased popular and professional attention over the past two decades. Various reports have highlighted the scale of such abuse, along with shortcomings in reporting practices. In this article, we outline some contemporary research that sought to understand the psychology that underpins variable reporting practices. In line with this research, we set out two conceptual frameworks that have some potential to help to explain such practices: system justification theory and moral foundations theory. Further, we describe how these frameworks could be adopted in research moving forward in order to make sense of the ways in which members of religious groups respond to allegations of child sexual abuse within their institutions. We close the article by arguing that by gaining a deeper understanding of the psychology underlying reporting practices, it may be possible to communicate more effectively about child sexual abuse within religious institutions, and therefore encourage more widespread reporting of allegations before more children are harmed.

‘We outline some contemporary research that sought to understand the psychology that underpins variable reporting practices’

Key Practitioner Messages

• Those most likely to observe or suspect child abuse in religious settings are themselves likely to participate in such settings.
• The challenge for these ‘onlookers’ is to overcome the psychological dynamics that push against the recognition and reporting of child abuse in religious settings.
• These dynamics can be understood via established psychological theories and frameworks.
• Practitioners concerned with improving reporting practice in these contexts can draw on this work to inform training and intervention strategies.

     

Playing safe: Media coverage of child sexual abuse prevention strategies

This paper examines the media coverage of preventing child sexual abuse. It draws on a content analysis of all press and TV news coverage about child sexual abuse that appeared in the UK during a complete 12-month period. The findings demonstrate that the bulk of the coverage was case-based, for example focusing on the Orkney case. There was very little opportunity for broader discussion of general issues of concern, including how sexual assaults against children might be prevented. The coverage of ‘prevention’ which did exist drew on a very narrow range of debates and was disproportionately concerned with abuse outside the home (abductions by strangers, or abuse within institutions such as schools or children's homes). Discussions about prevention were dominated by reactive news stories generated by particular ‘scandals’. The coverage was also largely drawn from a small constituency of official source agencies (such as government officials, court proceedings and police statements). There were few attempts to address the broader social conditions which might facilitate or inhibit sexual violence or to examine explicitly political analyses of the problem. The paper argues for a more diverse discussion about ways of preventing sexual violence against children, especially assaults by fathers, uncles, brothers and friends of the family. This demands close attention to the ways in which the mass media operate, as well as the priorities of source agencies. The paper points to factors within news production practices which both obstruct and facilitate debate about prevention and concludes by suggesting strategies to promote this issue as a vital part of the public agenda.     

The Seven Pillars of Quality Care in a Statewide Pediatric Sexual Assault Nurse Examiner Program

This article describes a systematic approach used by a statewide pediatric sexual assault nurse examiner program to ensure the quality of forensic medical examinations it provides in child sexual abuse investigations. Seven strategies for enhancing quality are described: (a) hiring experienced professionals, (b) effective training, (c) comprehensive protocols, (d) ample support for pediatric sexual assault nurses, (e) management oversight, (f) a clinical coordinator to provide ongoing training and technical assistance, and (g) a quality assurance process in which expert child abuse pediatricians review each statewide pediatric sexual assault nurse examination. To show the evolution of quality care over time, the program's experience from 2004 to 2010 is reviewed, and quality assurance data are analyzed.     

Training Mental Health Professionals in Child Sexual Abuse: Curricular Guidelines

This study explored whether counseling practices with women survivors of child sexual abuse reflect the belief that women do not sexually abuse children. Canadian therapists (n?=?164) who work with women survivors of child sexual abuse were surveyed about their beliefs about what constitutes child sexual abuse, who commits child sexual abuse, and their practices regarding inquiries about abusive behavior. A majority self-reported that they ask women and think it is important to ask but most believe that clients will not spontaneously self-disclose inappropriate sexual thoughts or behaviors. How broadly or narrowly therapists defined child sexual abuse was not related to self-reported therapeutic discussion. Therapists demonstrated differential gender beliefs about child sexual abuse perpetration, but this did not relate to self-reported counseling practices. Implications for therapist education are discussed.     

Perceived Needs for Support Program for Family With Child Sexual Abuse Victim in South Korea: Focus Group Interview With Therapists and Mothers

This study assessed perceived needs for psychological support program for family with victim of child sexual abuse in South Korea. We conducted two separate focus group interviews with five therapists who served child sexual abuse victims and families as well as four mothers of a child sexual abuse victim. Consensual qualitative research analysis revealed four domains: Emotional support for parents, psychoeducation, family therapy, and tailored and flexible service delivery. Core ideas of the four domains were identified. The results were consistent with the family support program contents developed in Western countries and suggested culture-specific contents and culturally sensitive service delivery. Clinical implications for developing family support program in South Korea were discussed.     

Child-Parent Relationship Therapy with Extra-Familial Abused Children

Sexual abuse by a perpetrator outside of the family is the most prevalent form of child sexual abuse. It is associated with serious consequences for both the child and his family. Surprisingly, however, the issue of extra-familial sexual abuse has received very little research and clinical attention. The purpose of the current study was to explore the effectiveness of Child-Parent Relationship Therapy (CPRT), which uses nondirective play therapy tools, among parents of extra-familial abused children and their parents. In order to do so, data was collected from 51 parents who participated in CPRT, at three points in time: pretreatment stage, at the beginning of the first meeting; and in the post treatment stage. The data included the parents’ reports via three questionnaires: Parenting Stress Inventory (PSI), Compassion Fatigue Self-Test (CFST), Child Behavior Checklist (CBCL). Overall, the results indicated a decrease in internalizing and externalizing symptoms among the children, as well as in parenting stress and in parental secondary trauma symptoms. This study contributes to the literature on interventions with victims of extra-familial child abuse and their parents. Specifically, the results highlight the benefits and importance of involving both parents and children in therapeutic interventions for victims of extra-familial child sexual abuse, with particular emphasis on the benefits of Child-Parent Relationship Therapy.     

Caregiver–Youth Communication about Sex in South Africa: The Role of Maternal Child Sexual Abuse History

Much of the research on child sexual abuse focuses on negative outcomes. This brief report explores a potentially protective parenting behavior among black South African female caregivers with and without a child sexual abuse history. Using cross-sectional baseline data, we hypothesized that caregiver child sexual abuse history would be positively associated with caregiver–youth sex communication and this relationship would be strongest for girls. Youth whose caregiver experienced child sexual abuse were more likely to report communicating with their caregiver about sex than youth whose caregivers did not experience child sexual abuse; however, this relation did not hold for caregiver reported communication. Child sexual abuse survivors’ ability and decision to discuss sex with their youth has the potential to protect youth from sexual risk and demonstrates resilience among a group rarely acknowledged for positive parenting practices.     

Evolving Narratives About Childhood Sexual Abuse: Challenging the Dominance of the Victim and Survivor Paradigm

This research project explored the ongoing process of constructing a narrative, following childhood sexual abuse. Twenty‐two men and women aged 25–70 were interviewed about their childhood sexual experiences with adults using narrative inquiry methodology. These experiences occurred in different social and historical contexts, when the theoretical understandings and treatment of the issue of child sexual abuse were significantly different from the present. Many factors made disclosure even more difficult then than it is now including: respect for authority; rigid gender roles; the taboo surrounding sexual issues; lack of supportive adults; and lack of language to describe what was happening. Participants told four differing narratives about their experiences: narratives of silence; narratives of ongoing suffering; narratives of transformation; and narratives of transcendence. These narratives were examined in relation to the changing social and historical context and the current dominance of the victim and survivor paradigm in the child sexual abuse literature.     

Gender Differences in Psychosocial Predictors of Attitudes Toward Reporting Child Sexual Abuse in the United Kingdom

There is a dearth of research investigating psychosocial correlates of attitudes toward reporting child sexual abuse in males and females and a lack of such studies drawing on participants from the United Kingdom. Therefore, the main objective of this article is to examine gender differences in social and psychological predictors of attitudes toward reporting child sexual abuse. Participants drawn from the United Kingdom general population were recruited via an opportunistic sampling method. Cross-sectional design using a self-report questionnaire was utilized. Hierarchical multiple regression analyses revealed that social support, masculinity, and age form significant associations with attitudes toward reporting child sexual abuse in females (total variance explained by the model was 25%). In the male sample, the only significant predictor of attitudes toward reporting child sexual abuse was interpersonal manipulation (total variance explained by the model was 9%). This study provides an important insight into psychosocial barriers and facilitators to reporting child sexual abuse. Such knowledge is crucial for the early detection and prevention of abuse.     

Childhood Sexual Abuse and Brain Development: A Discussion of Associated Structural Changes and Negative Psychological Outcomes

The effects of traumatic exposure have been researched for many years and studies have shown that the parts of the brain affected by sexually traumatic experiences in childhood are also linked to many physical and psychological problems, such as depression, posttraumatic stress disorder, somatic complaints and suicide. Neuroimaging studies have provided a breadth of evidence that childhood sexual abuse is related to structural changes in the brain. Taken together, childhood sexual abuse affects brain development, leading to differences in brain anatomy and functioning that have lifelong consequences for mental health. Several limitations of neuroimaging research on childhood sexual abuse are discussed, including a lack of refined and sensitive neuroimaging measures and problems interpreting results of structural imaged subjects with associated psychiatric conditions. Future, large‐scale studies are warranted to examine the type and severity of the sexual abuse and how each of the levels of childhood sexual abuse contributes to structural and functional changes. Furthermore, future studies are needed to control for comorbid psychiatric conditions in order to disentangle the effects of childhood sexual abuse from psychiatric conditions that damage brain development. © 2018 John Wiley & Sons, Ltd.

‘Childhood sexual abuse affects brain development, leading to differences in brain anatomy and functioning that have lifelong consequences for mental health’

Key Practitioner Messages

• Childhood sexual abuse is linked to observable structural changes in the brain.
• These structural changes in the brain are associated with a myriad number of negative psychological effects.
• Research is limited in elucidating the role of childhood sexual abuse on brain development, as the bulk of the research has focused only broadly on child maltreatment.

     

Exploring the link between sexualized behaviour and sexual abuse in a clinical setting

This study examined the issue of sexualized behaviour in children as an indicator of sexual abuse. The purpose was to develop alternative explanations for sexualized behaviour if sexual abuse was not confirmed or suspected. Other possible explanations explored were the presence of frequent disruptions to family life, previous unresolved exposure to sexual abuse or contact with a sexualized child. Data were collected on 81 cases of sexualized behaviour referred to a specialist child protection assessment unit over a 7‐year period. It was found that in very few cases was sexual abuse considered an explanation for the sexualized behaviour. Of the remaining cases, a substantial number showed evidence of family disruption, which could lead to sexualized behaviour developing as a comforting response for the child. Furthermore, a number of children also had experienced sexual abuse in the past, which might have been unresolved for the child, or had contact with another sexualized child, and this might have accounted for their behaviour. It would appear that many of the children were facing difficulties in their lives and might require therapeutic intervention, even if concerns about recent sexual abuse had been allayed. Copyright © 1999 John Wiley & Sons, Ltd.