CHILD MALTREATMENT IDENTIFICATION, PART II: Sexual Abuse and Exploitation

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CHILD MALTREATMENT IDENTIFICATION, PART II
Sexual Abuse and Exploitation

• California Common Core Training
• Version 1.1

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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.

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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.

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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

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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

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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?

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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?

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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

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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,)

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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

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Legal Definitions for Sexual Assault and Sexual
Exploitation

• California Welfare Institutions Code (WIC)
  Section 300(d)
• California Penal Code (PC) Sections 11164-11165

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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.
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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.

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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.

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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?

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Key Questions Law Enforcement

• Is the child safe?
• Did a crime occur, per the Penal Code?
• Is the alleged perpetrator safe in the community?

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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!

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Exercise Sexual Behavior Cards

• What do you think is
• NATURAL/HEALTHY,
• PROBLEMATIC/ OF CONCERN,
• or ABUSIVE/ SEEK PROFESSIONAL HELP?

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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?

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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.

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Adolescent Sexual Experience Quiz

• What do you know?
• Are these statements TRUE or FALSE?

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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

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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

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Gender Sexual Orientation Issues

• Double standard for males and females
• Sexual orientation

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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)

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Remember. . .

• Presence of Indicators ? Abuse

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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

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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

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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!

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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

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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.)

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Behavioral ElementsEmotional Distress

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

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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

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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

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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

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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.

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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

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A View From The Shadows

• Johnnys Story

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Sgrois Five Stages in CSA

• Engagement
• Sexual interaction
• Secrecy
• Disclosure
• Suppression

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Summit's Child Sexual Abuse Accommodation Syndrome

• Secrecy
• Hopelessness
• Entrapment and accommodation
• Delayed, conflicting, and unconvincing disclosure
• Retraction

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How do we see Sgrois Stages and Summits Child
Sexual Abuse Accommodation Syndrome

• in Johnnys disclosure?

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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

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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.

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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.

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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

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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!

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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

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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

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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.

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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
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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

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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)

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TRUTH, LIES, SEX OFFENDERS
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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.

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Information Gathering (Tab 3, pages 61 63)
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Information Gathering with a Child (Child
Welfare Perspective)

• Who
• Where (body parts, geographical)
• What
• How
• Documentation
• Clarification
• Closure
• Explanation of next steps

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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.

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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.

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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.

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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

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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.

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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.

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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.

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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

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Day Two

• Welcome Back!
• Questions, Comments, Clarifications

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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

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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

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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

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Alternative Hypotheses

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

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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?

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The Impact of Sexual Abuse

• SUSANS STORY

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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

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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

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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

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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

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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

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Embedded Evaluation

• Time to see what you have learned so far!

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Closure

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