Advances in understanding and treating childhood sexual abuse: implications for research and policy

Childhood sexual abuse is a major public health problem affecting thousands of children and adolescents in the United States each year. For more than 20 years, researchers, healthcare professionals, and policymakers have had considerable disagreements about various aspects of child sexual abuse. Although everyone agrees that sexual abuse is a harmful thing for children to experience, there is a lack of consensus on a definition of sexual abuse, investigation of allegations, long-term consequences, what constitutes appropriate psychotherapy, and what public health policies should be developed to prevent sexual abuse. The purpose of this article is to explore advances that have been made in understanding and treating child sexual abuse, to look at the implications for further research, and to address the public health policies that exist for preventing child sexual abuse.     

Child sexual abuse prevention programs in Texas public elementary schools

This survey determined if selected Texas public school districts provided an established child sexual abuse prevention program for elementary schools. The survey examined the type of program being implemented, training available for faculty and staff type of evaluation used, involvement of local agencies, and type of funding sources. Survey data were obtained from a nonrandomized sample of 89 largest public school districts in Texas, all recording an average daily attendance over 5,000. Fifty-eight of the 89 districts addressed child sexual abuse as a formal prevention program or as an awareness program. Training for child sexual abuse prevention program presenters was offered in 89% of districts. Consistent, effective evaluation was minimal. Funding for prevention programs was limited or unknown. Results confirmed the need for consistent, effective child sexual abuse prevention programs in elementary schools.     

Child abuse and neglect--a public health concern

OBJECTIVE: To review the phenomenon of child abuse and neglect from a public health perspective. DATA SOURCES: Literature review before the publication of the landmark article by the pediatrician C. Henry Kempe and coworkers in 1962, "The battered-child syndrome", and selected publications until the end of 1999. STUDY SELECTION: Studies published in the period before the discovery of the battered-child syndrome, studies after that publication dealing with the definition of child abuse and neglect, epidemiology of child abuse, fatal child abuse, child sexual abuse, emotional abuse, and domestic violence. DATA EXTRACTION: Studies or data linked to child physical abuse, neglect, psychological abuse, sexual abuse, structural abuse, other forms of abuse and domestic violence. DATA SYNTHESIS: In the 19th century more understanding for children's rights was acknowledged and in the 20th century child abuse was discovered in 1962 after many years of "looking with the blind eye". The number of reported cases of child abuse world wide has ever since exploded into a public health epidemic with a ten times higher incidence than cancer (child abuse rate: 40 per 1,000 population; cancer 3.9 per 1,000 population. CONCLUSIONS: Child abuse and neglect is complex, involving many professionals and agencies, which can be one of the reasons why the field has not been able to attract enough resources for prevention, treatment, education, and research. Child abuse must be looked upon as a major public health problem, and professionals must enter the new century with an effort to really make it a "century for the child."     

An exploration of child maltreatment among homeless families: implications for family policy

This research explores the incidence of child maltreatment among homeless families. The maltreatment explored in the study includes physical, emotional and sexual abuse. The data reported a high incidence of child maltreatment in the lives of the homeless. The policy implications for these findings are discussed.     

The construction of elder abuse as a social problem: a Canadian perspective

This article uses the social constructionist approach to social problems as claims-making activities and Blumer's theory of the developmental stages of social problems to analyze how elder abuse has been constructed as a social problem in Canada and how interest groups have been mobilized to deal with the alleged problem. Clearly, elder abuse has emerged as a social problem (often under the family violence rubric) and has received some legitimation from professional groups and representatives of government. Efforts to mobilize social action against elder abuse at a national level and to develop legislation and other policy initiatives have, however, so far met with mixed success. While elder abuse has been trumpeted by some claims-makers as a major new form of family violence, the absence of a strong elder lobby group and the absence of developed ideologies (e.g., feminism in the case of wife abuse and child sexual abuse) have resulted in elder abuse receiving much less attention than other problems grouped under the family violence rubric. Indeed, most of the legislation that presently exists in Canada deals not with the abuse of the elderly as a class but with the provision of services to dependent, incompetent adults whether they are elderly or not.     

The burden of child maltreatment in China: a systematic review

Objective

To estimate the health and economic burdens of child maltreatment in China.

Methods

We did a systematic review for studies on child maltreatment in China using PubMed, Embase, PsycInfo, CINAHL-EBSCO, ERIC and the Chinese National Knowledge Infrastructure databases. We did meta-analyses of studies that met inclusion criteria to estimate the prevalence of child neglect and child physical, emotional and sexual abuse. We used data from the 2010 global burden of disease estimates to calculate disability-adjusted life-years (DALYs) lost as a result of child maltreatment.

Findings

From 68 studies we estimated that 26.6% of children under 18 years of age have suffered physical abuse, 19.6% emotional abuse, 8.7% sexual abuse and 26.0% neglect. We estimate that emotional abuse in childhood accounts for 26.3% of the DALYs lost because of mental disorders and 18.0% of those lost because of self-harm. Physical abuse in childhood accounts for 12.2% of DALYs lost because of depression, 17.0% of those lost to anxiety, 20.7% of those lost to problem drinking, 18.8% of those lost to illicit drug use and 18.3% of those lost to self-harm. The consequences of physical abuse of children costs China an estimated 0.84% of its gross domestic product – i.e. 50 billion United States dollars – in 2010. The corresponding losses attributable to emotional and sexual abuse in childhood were 0.47% and 0.39% of the gross domestic product, respectively.

Conclusion

In China, child maltreatment is common and associated with large economic losses because many maltreated children suffer substantial psychological distress and might adopt behaviours that increase their risk of chronic disease.     

Teen pregnancy: a public health issue or political football?

Politicians in the US have made adolescent parents the scapegoat of changing cultural patterns by suggesting punitive solutions to nonmarital births rather than addressing underlying causes of premature child-bearing. It is known that the percentages of young people of all races and all social classes reporting early, nonmarital sexual intercourse have increased dramatically, while adolescent fertility rates peaked in the 1950s. Improved access to contraception and abortion caused a decline in teen pregnancy and birth rates from 1970 to 1986. During 1986-91, service providers could not match growing demand, and the birth rate increased 25%. Increased rates of sexual activity have also led to increases in the incidence of sexually transmitted diseases (STDs) and HIV/AIDS among adolescents. This situation was exacerbated by Reagan and Bush policies, which reduced funding for services to adolescents and supported abstinence-only sex education courses. The concern voiced by policy-makers today centers on nonmarital childbearing by low-income adolescents who will rely on public assistance to survive. A proper response to this situation would involve the following policy actions: 1) mandating comprehensive sexuality education from kindergarten through high school, 2) funding mentoring programs, 3) improving economic and educational opportunities, 4) expanding STD and HIV/AIDS prevention programs, 5) increasing access to confidential health services (including mental health care and substance abuse treatment), 6) expanding child sexual abuse prevention and intervention programs, and 7) increasing access to and acceptability of teen contraceptive usage and abortion.     

Child sexual abuse and premarital intercourse among high-risk adolescents

This study examined the extent to which child sexual abuse was associated with an increased likelihood of premarital sex among adolescents at high risk of sexual abuse. The sample consisted of 177 teenage girls who, because of evidence of family dysfunction, had become part of a public child welfare system. Half the sample had been placed in a foster home and the remainder were receiving protective services in their own home. About 40% of the teens in both groups had been sexually abused, although teens still living at home were less likely to have reported abuse. Victims of sexual abuse were found to be more likely to have engaged in voluntary sexual intercourse, even after background factors were controlled. Teens in foster home were somewhat less likely to be sexually active than the teens who remained at home.     

Child sexual abuse

Authors review the epidemiology of child sexual abuse. They summarize the individual, social and medico-legal aspects of sexual violence. They present an achievable approach for managing and preventing sexual crime concerning the circumstances of public health and the current laws in Hungary. Searching for specific signs and symptoms will facilitate the recognition of the cases and the success of the official procedure. In order to explore and to prevent child sexual abuse an interdisciplinary instruction is recommended on different educational levels.     

The aftermath of nonsubstantiated child abuse allegations in child care centers

With increasing numbers of children in child care, allegations of abuse in those facilities have also increased. Unsubstantiated findings of sexual abuse in child care centers comprise approximately 79% of all allegations. This study surveyed 28 centers in California that experienced an unproven child abuse charge within the last three years. Six administrators also agreed to be interviewed. Significant differences between unfounded and inconclusive findings were discovered when observing the time of investigation, staff attrition rates, type of allegation, investigatory agency rating, and staff support. Qualitative themes included staff helplessness and vulnerability, ethical paradoxes, and policy concerns. Parent and staff relations were also examined. Implications for investigations, policy, and staff training are discussed.     

Possible Futures for Social Work with Children and Families in Australia,the United Kingdom and the United States

There has been considerable interest in recent years in comparing the operation of social work services for children and families internationally, particularly between Australia, the United Kingdom and the United States. Reviewing the respective policy environments and drawing on recent research experience in these three nations, the author speculates as to how such services may be placed to respond to a converging agenda to tackle the high social and economic costs of social exclusion. It is argued that a conspiracy of circumstances have led child and family social work away from its more general child welfare objectives of the past and have created consolidation of functions in relation to child-protection work. This has left services ill-prepared to play a central role within a new and resurgent child welfare agenda. If child-protection systems are to successfully metamorphose to encompass child welfare ideals, they will need to reconfigure to help shape their own future. This future will be concerned with the identification of, and service provision to, marginalised populations predicted to create high lifetime social and economic costs for society—the alternative being a default to the reductionist position of child-protection agencies largely concerned with the management of “child abuse”.     

The influence of child abuse on the pattern of expenditures in women's adult health service utilization in Ontario, Canada

Childhood maltreatment is a common and serious problem for women, particularly in relation to impairment in adulthood. To our knowledge, no system-wide study has addressed the influence of childhood maltreatment on the cost of these women's adult health service utilization. This paper examines this relationship. The 1990 Ontario Health Survey (OHS) gathered information regarding determinants of physical health status and the use of health services. The 1991 Ontario Mental Health Supplement (OHSUP) examined a variety of childhood experiences as well as the prevalence of psychiatric disorders from a sample of OHS respondents. These were province-wide population health surveys of a probability-based sample of persons aged 15 years and older living in household dwellings in Ontario. The OHSUP randomly selected one member from each participating OHS household to be interviewed regarding personal experiences and mental health. This analysis used data from women aged 15-64 who participated in both the OHS and OHSUP. Self-reported health service utilization was collected in four groups of women--those who reported no history of child abuse, those with a history of physical abuse only, those who reported sexual abuse only, and those who reported both physical and sexual (combined) abuse. We hypothesized that a history of child abuse would result in greater adult health care costs. The results indicated that having a history of combined abuse nearly doubles mean annual ambulatory self-reported health care costs to 775 dollars (95% CI 504 dollars-1045 dollars) compared to a mean cost of 400 dollars with no abuse (95% CI 357 dollars-443 dollars). Median annual ambulatory self-reported health care costs were also increased in the combined abuse group, to 314 dollars (95% CI 220 dollars-429 dollars), compared to 138 dollars (95% CI 132 dollars-169 dollars) in those with no abuse. We conclude that child abuse in women is significantly associated with increased adult self-reported health care costs.     

Denormalizing a historical problem: teen pregnancy, policy, and public health action

OBJECTIVE: To explore the impact of teen-adult sexual relationships as a public health threat and the effectiveness of statutory rape laws in protecting adolescent children. METHODS: A comprehensive review of current literature surrounding child abuse, teen pregnancy, and statutory rape was conducted. RESULTS: Of one million teen girls who become pregnant each year, two-thirds may be the victims of statutory rape. Current laws appear to marginalize the severity of teen- adult sexual relationships, compromising the health and safety of adolescent children. CONCLUSIONS: Public health recommendations which include public policy change and enforcement, education, and community empowerment are offered.     

Grandparents raising grandchildren:kinship care in Baltimore public housing

Life circumstances and threatening ecologies disenfranchise families living in public housing development. Many are children who live with their grandparents in housing units, but are not on the lease. The grandparents and grandchildren experience health problems, are in poverty, and are not served by the child welfare system. Frequently, the children are forced to sleep in bedrooms with other individuals who may be inappropriate, subjecting them to potential sexual child abuse and other circumstances. Housing officials are compelled to remedy this problem and ensure that all residents of public housing are on the lease and are properly housed consistent with the U.S. Housing Act of 1932. National housing policy needs to be reformed to accommodate the needs of children who for a range of circumstances cannot live with their parents. doi:10.1300/J045v22n03_11.     

The Child Sexual Abuse Epidemic in Addis Ababa: Some Reflections on Reported Incidents,Psychosocial Consequences and Implications

Background

Though child sexual abuse is a universal phenomenon, only reported cases of the incidence are common source of information to get insight on how to understand the problem. Besides, investigating complaints presented by victims themselves would be a stepping stone for designing prevention and rehabilitation programs. The objective of this study was to identify the nature of sexual incidence and experience victims face.

Methods

The research was conducted by collecting reported child sexual abuse cases from Child Protection Units of Addis Ababa Police Commission and three selected non-governmental organizations working for the welfare of sexually abused children in Addis Ababa. 64 selected samples of victim children were included from the three organizations. They completed a semi-structured questionnaire and data were analyzed.

Results

Of the total reported crime cases committed against children (between July 2005 and December 2006), 23% of them were child sexual victimization. On average, 21 children were reported to be sexually abused each month where majority of the sexual abuse incidence were committed against female children in their own home by someone they closely know. The psychological trauma and physical complaints presented by victims include symptoms of anxiety and depression.

Conclusion

It was found out that child sexual abuse cases presented to the legal office was not properly managed. Female children appear to be more prone to sexual abuse than their male counterparts. By virtue of their nature, many children are at risk of sexual victimization by people they truest. Based on the findings, several implications are made, which includes the importance of nation-wide study to formulate a comprehensive policy guideline for protection and criminalization of child sexual abuse in Ethiopia.     

Sexual incidents in residential treatment

Increasing awareness regarding the prevalence of sexual abuse as a significant factor for clients in residential treatment has created an even greater need for data, training, and policy development in the long-ignored area of clinical management of sexual incidents. This study presents an analysis of a survey of critical sexual incidents reported by 95 child care workers in three agencies. Implications for training and therapeutic intervention are discussed.     

Trends in adolescent sexual risk behaviors

Many societies worldwide are faced with an increase in adolescent pregnancy, rape, sexual abuse and sexually transmitted disease due to different sexual behaviors and sometimes lack of responsible sexual behaviors. The World Health Organization and the Surgeon General of the United States Government have called for action to this serious public health issue. In this short communication data from the United States, Canada and Israel is presented with a call for a professional response to this public health challenge.     

Country watch: international

The International Tribunal for Children's Rights (ITCR) was established to conduct individual and public inquiries and propose concrete solutions to violations of children's rights. This article reports on the efforts of the ITCR to enforce extraterritorial laws in response to the international dimension of child sex exploitation. The primary message being advocated is that travelers cannot go to foreign countries to engage in sexual crimes against children, evade criminal prosecution in the countries where the crimes are committed and then expect to return home without any consequences. In its first public hearings held in Paris, France to the address the effectiveness of extraterritorial legislation, governments and nongovernmental organizations informed the ITCR about their attempts to halt child sexual exploitation. Several changes needed to make extraterritorial laws more effective were cited. These include public awareness-raising; supporting existing instruments; application of preventive approaches to child abuse; and sensitizing and motivating judicial, police and administrative authorities to provide for the needs to fight child sex tourism.     

Working sensitively with child sexual abuse survivors: what female child sexual abuse survivors want from health professionals

Adult survivors of child sexual abuse are high users of health and mental health services. Health professionals are well placed to improve health outcomes for them by delivering positive interventions post-abuse. The current study explored female child sexual abuse survivors' opinions on how health professionals could work better with child sexual abuse survivors. Sixty-one women, from 22-65 years old, who had been sexually abused before the age of 16 years, completed postal questionnaires in late 2004. A model was developed to guide the development of knowledge, skills, and practices for working more sensitively with child sexual abuse survivors. The model consisted of six chronological training steps: (1) knowledge on effects of child sexual abuse; (2) establishing the relationship with child sexual abuse survivors; (3) asking about child sexual abuse; (4) responding to disclosure; (5) sensitive provision of medical examinations; and (6) follow-up post examination. A systematic approach to training is proposed to assist with improving delivery of services sensitive to child sexual abuse survivor needs.     

Working Sensitively with Child Sexual Abuse Survivors: What Female Child Sexual Abuse Survivors Want from Health Professionals

Adult survivors of child sexual abuse are high users of health and mental health services. Health professionals are well placed to improve health outcomes for them by delivering positive interventions post-abuse. The current study explored female child sexual abuse survivors' opinions on how health professionals could work better with child sexual abuse survivors. Sixty-one women, from 22–65 years old, who had been sexually abused before the age of 16 years, completed postal questionnaires in late 2004. A model was developed to guide the development of knowledge, skills, and practices for working more sensitively with child sexual abuse survivors. The model consisted of six chronological training steps: (1) knowledge on effects of child sexual abuse; (2) establishing the relationship with child sexual abuse survivors; (3) asking about child sexual abuse; (4) responding to disclosure; (5) sensitive provision of medical examinations; and (6) follow-up post examination. A systematic approach to training is proposed to assist with improving delivery of services sensitive to child sexual abuse survivor needs.