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CHILD MALTREATMENT IDENTIFICATION, PART II: Sexual Abuse and Exploitation

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Title: CHILD MALTREATMENT IDENTIFICATION, PART II: Sexual Abuse and Exploitation


1
CHILD MALTREATMENT IDENTIFICATION, PART II
Sexual Abuse and Exploitation
  • California Common Core Training
  • Version 1.1

2
Learning Objectives/Overview
  • Present the historical background, legal
    definitions and dynamics of child sexual abuse
  • Discuss characteristics of perpetrator, victim,
    and non-offending caretaker
  • Identify physical, behavioral, and emotional
    indicators of child sexual abuse
  • Examine the dynamics involved in sexual abuse and
    sexual exploitation
  • Practice identifying child sexual abuse when
    allegations occur.

3
History Current U. S. Discovery Cycle
  • Some publications for specific disciplines began
    to appear in the early 1980s.
  • Stranger-Danger was believed to be the most
    common form of child sexual molestation.
  • During this same time period, the
    McMartin/Manhattan Beach, Country Walk, and
    Jordon, MN multiple victim cases involving
    pre-schoolers were publicized.

4
History System Responses
  • Mandatory Reporting
  • Specialized Investigative Units Formed
  • Government Sponsored Trainings Developed
  • Joint Investigations Between CPS LE Begun
  • Increased Criminalization of Incest
  • Child Advocacy Center Concept Begins
  • State and Federal Laws Enhanced or Developed
  • Research on Child Sexual Abuse Begins
  • Child Interviewing Protocols Developed

5
And Now For You
  • Possible personal difficulties in working cases
    with sexual aspects
  • Emotional reactions are expected and normal
  • Matters dealing with sexualized behaviors are
    very personal and value laden
  • Sexual abuse victimization history
  • Parenthood
  • Personal feelings concerning sexuality, sexually
    motivated behaviors, and children and sexuality

6
Questions For You
  • Where and under what conditions you were taught
    or learned about sex, sexuality, and what is
    appropriate or inappropriate sexual behaviors?
  • Who informed you?
  • What were your emotions and what caused them?
  • Girls were told by? Boys were told by?
  • Cultural Differences?

7
Question for you. . .
  • What are some ways that your own views of
    sexuality may impact your handling of situations
    involving the sexual abuse of children?

8
Exercise Body Part Identification
  • All terms or phrases are considered
  • Clinical/ proper
  • Slang/ Euphemisms
  • Cultural
  • Write on post-its and place on appropriate body
    part
  • Most post-its up wins for the team

9
General Definition Components
  • Sexual contact that is accomplished by threats or
    threat of force, regardless of the ages of
    participants
  • All sexual contact between an adult and a child
    regardless of whether there is deception or the
    child understands the sexual nature of the
    activity
  • Sexual contact between a teenager and a younger
    child can also be abusive if there is a
    significant disparity in age, development, or
    size, rendering the child victim incapable of
    giving informed consent. (Ryan, 1991)
  • See California Penal Code 11165.1(a,b,c,)

10
Continuum of Behaviors
  • Non-contact sexual acts such as exposure,
    voyeurism, showing or producing pornography,
    masturbation or other sexual acts in front of the
    child
  • Touching of the sexual or erogenous zones or
    touching designed for the sexual gratification of
    the perpetrator or for the furtherance of sexual
    activity
  • Penetration of vagina, anus, mouth

11
Legal Definitions for Sexual Assault and Sexual
Exploitation
  • California Welfare Institutions Code (WIC)
    Section 300(d)
  • California Penal Code (PC) Sections 11164-11165

12
Informed Consent
  • The dimensions of informed consent
  • 1. Know what is being requested
  • 2. Have a thorough understanding of the
    consequences of the behavior
  • 3. Have an equal power base in the relationship
  • 4. Be able to say no without repercussions

Abel, G.G., Becker, J.V., Cunningham-Rathner.
(1984). Complications, consent, and cognitions in
sex between children and adults. International
Journal of Law and Psychiatry, 7, 89-103.
13
Prevalence
  • 9.7 of maltreatment reports involve sexual abuse
    (2004)
  • of American females who are sexually abused or
    exploited in some manner before 18
  • 1 in 3-4
  • of American males who are sexually abused or
    exploited in some manner before 18
  • 1 in 7-10 (underreporting a major issue)
  • 90-95 of sexual abuse is perpetrated by someone
    the child knows.

14
Prevalence
  • The challenge of the numbers
  • All are estimates and have limitations
  • Different studies use different definitions.
  • Child abuse reporting and clinical programs tend
    to over-represent intrafamilial cases.
  • Cases reported by official agencies meet a
    particular standard, many cases never get
    reported so these data sources underestimate the
    number of victims.
  • Numbers are reported for different time periods.

15
Key Questions Child Welfare
  • Does the allegation involve intra-familial abuse?
  • Is the child safe?
  • Did abuse occur, per WIC Section 300?
  • Also refer to Trainee Content re When
    Consensual Sexual Intercourse is Deemed Child
    Abuse in California
  • Is the caregiver able/willing to protect the
    child?
  • Is there a viable safety plan to allow the child
    to stay in the home?

16
Key Questions Law Enforcement
  • Is the child safe?
  • Did a crime occur, per the Penal Code?
  • Is the alleged perpetrator safe in the community?

17
Sexual Behaviors
  • Research has also demonstrated a consistent
    relationship between sexual abuse and sexual
    behaviors in pre-adolescent children.
  • HOWEVER, a broad range of sexual behaviors has
    been observed in children who do not have a
    history of sexual abuse.
  • Important to be aware of what is normal sexual
    development, including related behaviors,
    interactions, and feelings for the growing child!

18
Exercise Sexual Behavior Cards
  • What do you think is
  • NATURAL/HEALTHY,
  • PROBLEMATIC/ OF CONCERN,
  • or ABUSIVE/ SEEK PROFESSIONAL HELP?

19
When do sexual behaviors need to be addressed?
  • Is the behavior putting the child at risk for
    physical harm, disease or exploitation?
  • Is the behavior interfering with the childs
    development, learning, social or family
    relationships?
  • Is the behavior violating a rule?
  • Is the behavior causing the child to feel
    confused, embarrassed, or bad?
  • Is the behavior causing others to feel
    uncomfortable?
  • Is the behavior abusive because it involves lack
    of informed consent, some type of coercion or
    lack of equality?

20
Importance of Context
  • Observers of childrens normal sexual behaviors
    note
  • It is curious in nature
  • Children involved in normal sex play are
    generally of similar age, size, and developmental
    status
  • Children participate on a voluntary basis
  • It is balanced by curiosity about other aspects
    of their lives
  • Does not usually leave children with deep
    feelings of anger, shame, fear, or anxiety
  • The affect of children regarding their sexual
    behavior is generally light-hearted and
    spontaneous.

21
Adolescent Sexual Experience Quiz
  • What do you know?
  • Are these statements TRUE or FALSE?

22
Child Sexual Abuse in a Cultural Context
  • Acceptance and manifestation of sex and sexuality
    within cultures
  • Appropriate and inappropriate sexual behaviors
    and participants
  • Sanctions
  • Sexual orientation, gender identification
  • Assignment of responsibility and/or blame

23
Cultural Aspects of Shame in Child Sexual Abuse
  • Responsibility for the abuse
  • Failure to protect
  • Fate
  • Damaged goods
  • Virginity
  • Predictions of a shameful future
  • Promiscuity, homosexuality, sexual offending
  • Re-victimization
  • Layers of shame

24
Gender Sexual Orientation Issues
  • Double standard for males and females
  • Sexual orientation

25
Elements to consider in Identifying Child Sexual
Abuse
  • Commonly referred to as indicators
  • Four broad areas
  • Reporting (including aspects of the allegation
    and disclosure)
  • Physical (including medical indicators)
  • Behavioral (including emotional indicators for
    the victim) and
  • Familial (including family and caregiver dynamics)

26
Remember. . .
  • Presence of Indicators ? Abuse

27
Reporting Elements
  • Credibility of the report (and the reporter)
  • Type and credibility of the childs disclosure
  • Corroboration of disclosure/report
  • Statements about prior unreported sexual abuse
  • History of CWS involvement

28
Physical Elements
  • Presence of illness or injury (ies)
  • Report of past illness or injury (ies)
  • Explanation of illness or injury (ies)
  • Developmental abilities of alleged victim
  • Developmental abilities of alleged perpetrator
  • Medical assessment findings

29
Physical Elements Medical Assessments
  • When?
  • In all cases in which the most recent episode of
    abuse/assault occurred within the last 72 hours
  • When penetration is disclosed, regardless of time
  • To assess any injury/pain/physical complaints of
    the child
  • When the child would benefit from a medical
    opinion
  • Know your countys protocols!

30
Behavioral Elements
  • History of sexually abusive behavior by someone
    in the home or with access to the child
  • Developmentally or socially inappropriate sexual
    knowledge and/or sexual behavior by alleged
    victim
  • Self-protective behavior by alleged victim
  • Indicators of emotional distress by alleged
    victim
  • Coaching or grooming behaviors

31
Behavioral ElementsEmotional Distress
  • Trauma-related indicators
  • Physiological reactivity/Hyperarousal
    (hypervigilance, panic and startle responses,
    etc.)
  • Retelling and replaying of trauma and
    post-traumatic play
  • Intrusive, unwanted images and thoughts and
    activities intended to reduce or dispel them
  • Sleeping disorders with fear of the dark and
    nightmares
  • Dissociative behaviors (forgetting the abuse,
    placing self in dangerous situations related to
    the abuse, inability to concentrate, etc.)

32
Behavioral ElementsEmotional Distress
  • Anxiety-related indicators
  • Obsessive cleanliness
  • Self-mutilating or self-stimulating behaviors
  • Changed eating habits (anorexia, overeating,
    avoiding certain foods)

33
Behavioral ElementsEmotional Distress
  • Depression-related indicators
  • Lack of interest in participating in normal
    physical activities, loss of pleasure in
    enjoyable activities
  • Social withdrawal and the inability to form or to
    maintain meaningful peer relations
  • Profound grief in response to losses of
    innocence, childhood, and trust in oneself, trust
    in adults
  • Suicide attempts
  • Low self-esteem, poor body image, negative
    self-perception, distorted sense of ones own body

34
Behavioral Elements Emotional Distress
  • Other indicators
  • Personality changes
  • Temper tantrums
  • Running away from home
  • Premature participation in sexual relationships
  • Aggressive behaviors
  • Regressive behaviors in young children (thumb
    sucking or bedwetting)
  • Poor school attendance and performance
  • Somatic complaints
  • Accident proneness and recklessness

35
Familial Elements
  • Isolation of the child (inhibits reporting and
    makes child more vulnerable)
  • Coercion/threats made to the child to prevent
    disclosure
  • Current caregivers substance abuse
  • Opportunity for the abuse to occur

36
Myths and Facts about the Forensic Medical
Examination
  • The medical examination will confirm if there was
    sexual abuse.
  • If sexual abuse occurred, there will be findings.
  • Exams can confirm if a girl is a virgin or not.
  • The examination will likely be traumatic for the
    child.
  • The exam mimics an adult gynecologic exam.
  • If a childs pediatrician did an exam, that is
    sufficient.

37
Myths and Facts about the Forensic Medical
Examination
  • The medical examination will confirm if there was
    sexual abuse.
  • Myth
  • If sexual abuse occurred, there will be findings.
  • Myth
  • Exams can confirm if a girl is a virgin or not.
  • Myth
  • The examination will likely be traumatic for the
    child.
  • Myth
  • The exam mimics an adult gynecologic exam.
  • Myth
  • If a childs pediatrician did an exam, that is
    sufficient.
  • Myth

38
A View From The Shadows
  • Johnnys Story

39
Sgrois Five Stages in CSA
  • Engagement
  • Sexual interaction
  • Secrecy
  • Disclosure
  • Suppression

40
Summit's Child Sexual Abuse Accommodation Syndrome
  • Secrecy
  • Hopelessness
  • Entrapment and accommodation
  • Delayed, conflicting, and unconvincing disclosure
  • Retraction

41
How do we see Sgrois Stages and Summits Child
Sexual Abuse Accommodation Syndrome
  • in Johnnys disclosure?

42
What Is the Evidence?Child Disclosures of Sexual
Abuse
  • Summary of Research Findings
  • (Olafson Lederman, 2006)
  • Majority of CSA victims do not disclose their
    abuse during childhood

43
Olafson Lederman (2006), contd
  • 2. When children do disclose sexual abuse during
    childhood, it is often after long delays.
  • 3. Prior disclosure predicts disclosure during
    formal interviews.
  • 4. Gradual or incremental disclosure of child
    sexual abuse occurs in many cases, so that more
    than one interview may become necessary.
  • 5. Experts disagree about whether children will
    disclose sexual abuse when they are interviewed.
    However, when both suspicion bias and
    substantiation bias are factored out of studies,
    studies show that 42 to 50 of children do not
    disclose sexual abuse when asked during formal
    interviews.

44
Olafson Lederman (2006), contd
  • 6. School-age children who do disclose are most
    likely to first tell a caregiver about what
    happened to them.
  • 7. Children first abused as adolescents are most
    likely to disclose than are younger children, and
    they are more likely to confide first in another
    adolescent than to a caregiver.
  • 8. When children are asked why they did not tell
    about the sexual abuse, the most common answer is
    fear. Recantation rates range from 4 to 22.
  • Lack of maternal or paternal support is a strong
    predictor of childrens denial of abuse during
    formal questioning.
  • Many unanswered questions about childrens
    disclosure patterns remain, and further
    multivariate research is warranted.

45
Olafson Lederman (2006), contd
  • Additional factors that affect childrens
    disclosure of sexual abuse
  • Abuse by a family member may inhibit disclosure
  • Dissociative and post-traumatic symptoms may
    contribute to non-disclosure
  • Modesty, embarrassment, and stigmatization may
    contribute to non-disclosure and

46
Non-Offending Parent/Caregiver Reactions
  • Reactions you may see
  • Denial
  • Anger
  • Bargaining
  • Depression
  • Resolution
  • BUT- Change and movement between the reactions
    can happen and will!

47
Why dont moms believe?
  • Anger
  • Disbelief
  • Denial
  • Shame
  • Guilt
  • Self-blame
  • Hurt
  • Betrayal
  • Confusion and doubt
  • Own abuse history
  • Jealousy
  • Sexual inadequacy or rejection
  • Minimization
  • Revenge
  • Financial or other fears
  • Religious concerns
  • Protect perpetrator
  • Hatred
  • Repulsion

48
Why dont moms protect?
  • Behaviors can be viewed on a continuum
  • Knows nothing
  • Has knowledge and does nothing
  • Recognizes potentially abusive behaviors,
    ineffectual or no protection
  • May sense something isnt right, but doesnt
    ask
  • Recognizes potentially abusive behaviors, acts to
    reduce risk or intervene

49
Why dont moms protect?
  • Growing evidence shows when mothers are
    incapacitated in some way children are more
    vulnerable to abuse. This may take a variety of
    forms
  • Absent due to divorce, sickness, or death
  • Emotional disturbances, psychologically absent
  • Their own intimidation, fear, or abuse
  • Large power imbalance with perpetrator undercuts
    her ability to be an ally for her children.

50
Perpetrator Dynamics
  • Rule 1 They dont look or act the way youd
    expect
  • -No profile of offender
  • -Have a public self vs. private self

Rule 2 The rules of logic do not apply -
Need-based cognitive distortions - They come to
believe their own distortions
51
Perpetrator Continuum
  • Situational
  • Do not have a true preference for children
  • May molest for a wide variety of reasons
  • More likely to be aroused by adult pornography
  • Frequently molest readily available children that
    they have easy access to
  • Victims young, vulnerable, accessible, less
    likely to be believed, easy to manipulate or
    threaten

52
Perpetrator Continuum
  • Preferential
  • Primary sexual orientation is toward children
  • Over represented in the higher SES groups
  • Behavior tends to be scripted, compulsive, and
    primarily fantasy-driven.
  • More specific sexual preferences as to age,
    gender, body type
  • Pornography usually focuses on the themes of
    their sexual preference (children)

53
TRUTH, LIES, SEX OFFENDERS
54
Finklehors Four Pre-Conditions to CSA
  • Motivation of the perpetrator to sexually abuse.
  • Internal inhibitors against acting out abuse.
  • External inhibitions against acting out abuse.
  • Resistance of the child to the attempted abuse.

55
Information Gathering (Tab 3, pages 61 63)
55
56
Information Gathering with a Child (Child
Welfare Perspective)
  • Who
  • Where (body parts, geographical)
  • What
  • How
  • Documentation
  • Clarification
  • Closure
  • Explanation of next steps

56
57
What is a Forensic Interview?
  • A forensic interview is conducted with the
    expectation that it will become part of a court
    proceeding.
  • It is intended for a judicial audience and
    governed by rules of evidence.
  • Its goal is to obtain facts for a court trial or
    hearing.
  • The forensic interviewer strives to
  • maintain a neutral and objective stance, to
    facilitate the childs recall of previous events
    they witnessed or experienced.
  • To ascertain the childs competence to give
    accurate and truthful information.

58
Examples of General Questions
  • Which is better?
  • Do you know why youre here today?
  • or
  • Tell me why youre here today.
  • Do you know why were talking today?
  • or
  • Tell me why were talking today.

59
Avoid These Questions!
  • Leading (The answer to the questions is quite
    clear in the question itself)
  • Your mother rubs your private parts, doesnt she?
  • Coercive Statements (Interviewer offers the child
    something in return for an appropriate response)
  • You cant go home until you tell me who did this.
  • If you tell me who did this to you, Ill buy you
    some ice cream.

60
Information Gathering Child Victims (also
refers to section on Impact of Abuse)
  • Guilt
  • Damaged Goods belief
  • Blurred physical boundaries
  • Sexualized behaviors
  • Ability to say NO
  • Difficulty in talking about taboo material
  • Embarrassment, shame, anger, fear
  • Location of interview
  • Degree of privacy
  • Rapport with interviewer
  • Previous decision to disclose
  • Questioning style of the interviewer
  • Presence of a witness (supportive or otherwise)
  • Response of other adults to previous disclosures
    of maltreatment

61
Information Gathering Non-Offending Parent
  • Expect denial, disbelief, minimization,
    projection of blame and possibly hostility toward
    you
  • Choose interview location where perpetrator has
    little or no power
  • Explore observations, time frames, relationships,
    mental health issues (depression), use of
    medications, sexual abuse/activity history
    possibility of DV/ emotional abuse, support
    system, etc.
  • Prepare for it to take some time before attitude
    or belief changes.

62
Information Gathering Non-Offending Parent
  • Assess dependency issues drug/alcohol use
  • Assess ability to emotionally support child or
    children
  • Anything you tell them, you need to provide in
    writing
  • Assess ability to carry through safety plan and
    investigative requirements (willingness and/or
    cognitive or logistical ability)
  • Be prepared to allow ventilation time
  • Always leave the door open for further
    conversations
  • Really LISTEN to what their primary concerns are.

63
Issues With Non-Abused Siblings
  • May be angry with victim for telling (decisional
    balance) and the consequences of disclosure
  • May develop negative behaviors or withdrawal as
    they cope with situation
  • Parent/s may develop and enforce rules to reduce
    the risk of sibs being victimized, causing
    resentment and rebellion
  • Need to be included in any treatment plan.

64
Information Gathering Perpetrator
  • Law enforcement involvement
  • Who, where, what are you interviewing for?
  • Denial 1st response
  • Minimization of behaviors
  • Justification
  • Blame onto victim or spouse
  • Sick and sympathy

65
Day Two
  • Welcome Back!
  • Questions, Comments, Clarifications

66
Assessment
  • Physical and Behavioral Indicators
  • Childs Disclosure
  • Evidence Discovery
  • Collateral Information
  • Child/ Family/ Perpetrator History
  • Alternative Hypotheses/ Confirmatory Bias
  • Source Monitoring
  • Perpetrator Admission or Confession

67
Cultural Considerations
  • What is the general cultural perception of the
    act/s?
  • How best to structure approach to child and
    family
  • Relationship with authority/government entities
  • Shame for the child, parent/s, community
  • Language proficiency, taboo topics or words

68
Analyzing the Childs Statement
  • Multiple events/elements of progression
  • Explicit sexual knowledge
  • Richness of details/idiosyncratic details
  • Internal logic/feasibility
  • Secrecy
  • Presence of pressure, coercion, enticement
  • Childs perspective of events

69
Alternative Hypotheses
  • Reasonable alternative explanations for what the
    child is describing or other elements uncovered
    through the investigative process.

70
Validation of the Referral
  • Looking at the totality of the information
    gathered from all sources, does it
  • Fit professional knowledge of dynamics of child
    sexual abuse?
  • Is there a secondary gain for one of the
    principals?
  • Is there medical validation/ support?
  • Is there physical evidence to support allegation?
  • Is there prior history?

71
The Impact of Sexual Abuse
  • SUSANS STORY

72
Information Gathering Child Victims (also
refers to section on Impact of Abuse)
  • Guilt
  • Damaged Goods belief
  • Blurred physical boundaries
  • Sexualized behaviors
  • Ability to say NO
  • Difficulty in talking about taboo material
  • Embarrassment, shame, anger, fear
  • Location of interview
  • Degree of privacy
  • Rapport with interviewer
  • Previous decision to disclose
  • Questioning style of the interviewer
  • Presence of a witness (supportive or otherwise)
  • Response of other adults to previous disclosures
    of maltreatment

73
Case Management Considerations
  • Separating the Family
  • Perpetrator from family
  • Child/children from family
  • Collaboration and Monitoring
  • Multidisciplinary team functioning
  • Developing and monitoring treatment plan/s
  • Visitation/ Reunification
  • If, when, and how

74
Treatment Considerations for Victims
  • Treatment Approaches
  • Supportive
  • Symptom-focused
  • Abuse focused
  • Visit this website for Evidence Based Practice
  • http//www.cachildwelfareclearinghouse.org
  • Treatment Issues
  • Foster healthy expression of feelings related to
    abuse
  • Reframe/correct distorted thinking about the
    abuse
  • Assist the child in understanding nature and
    impact of abuse
  • Reduce behavioral symptoms and emotional distress
  • Sex education assertiveness self-esteem
    empowerment personal safety

75
Treatment Issues for the NOP
  • Treatment Approaches
  • Supportive
  • Psychoeducational
  • Abuse-focused
  • Treatment Issues
  • Enhance Safety/Reduce Risk!
  • Believe abuse occurred
  • Hold perpetrator responsible
  • Empathy/ support for child
  • Identification of their own role in abuse
  • Resolution of own abuse/victimization issues
  • Foster independence

76
Treatment Issues for Perpetrator
  • Treatment Approaches
  • Cognitive
  • Behavioral
  • Relapse prevention
  • Offense-specific
  • Treatment Issues
  • Accept responsibility for behaviors
  • Develop/demonstrate empathy for victims and
    others
  • Modification of thinking errors/cognitive
    distortions
  • Identify and reduce/control deviant sexual
    arousal
  • Resolution of own childhood abuse/victimization

77
Embedded Evaluation
  • Time to see what you have learned so far!

78
Closure
  • THANK YOU AND GOOD LUCK TO YOU IN YOUR CHILD
    WELFARE WORK WITH CHILDREN AND THEIR FAMILIES.
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