Abuse Claims Research Articles

THE FOSTER CARE OMBUDSMAN: APPLYING AN INTERNATIONAL CONCEPT TO HELP PREVENT INSTITUTIONAL ABUSE OF AMERICA'S FOSTER YOUTH

Children today are often abused while in foster care, undermining the theoretical goal of the modern foster care system: to create a temporary, safe, homelike setting to protect and nurture children who are unable to live with their biological parents due to various reasons such as abuse, neglect, or abandonment. Often this abuse is worse than the type for which they were removed from their parents’ care in the first place. First examining the reasons why this complex problem exists, this Note recommends an internationally based, innovative concept as a partial solution: the foster care ombudsman. This Note explains the concept of an ombudsman and demonstrates how it can be particularly helpful to foster children, highlighting existing child welfare ombudsman offices in California, Rhode Island, and New Jersey, as well as international approaches. It also illustrates how a foster care ombudsman can complement class action litigation of foster care abuse claims.

A View From Riggs: Introduction to Paper II “Treatment Resistance and Patient Authority”

Periodically I do a call-in radio show on local public radio. Anonymous individuals call in to ask a psychiatrist questions about psychiatric diagnosis, medications, psychotherapy, stigma, suicide, and other issues, and I endeavor to connect briefly with them, acknowledge their struggles, and then offer a brief commentary in response, always noting I cannot offer treatment advice based on such a brief encounter. Recently I received a particularly compelling call. “Bob” reported, his voice communicating vulnerability and sadness, that he was a victim of clergy abuse who had struggled for years with depression and other symptoms. The church had accepted his claim of abuse and was now helping him receive treatment. Bob’s concern was that, apparently for financial reasons, church officials were pressuring him to use medications rather than psychotherapy in his treatment. He wondered if I had any advice about how to speak to church officials about his sense he needed therapy and his reluctance to take medications. Bob then added, painfully, that the pattern of his abuse had included substances being forced on him by his abuser. I responded to Bob that I could hear in his voice how hard it was to speak about this. Although I could not weigh in on his particular treatment needs, it was true that medications were often used with benefit in such situations. However, I could also appreciate the way he must experience pressure from the church to take medications as a repetition of the trauma. Unwittingly, the church, in its effort to take responsibility for the improper actions of one of its agents, was repeating the problem and becoming the abuser by forcing him to take drugs and submit to their desire. I suggested he be frank with them about this repetition, and also suggested he give them a copy of Nemeroff’s paper (Nemeroff et al., 2003) suggesting that chronically depressed individuals with trauma histories responded better to psychotherapy than to medications. Bob’s story illustrates the way abuse can be transmitted and re–created in moving from one situation to another, despite the best of inten

Considerations for experts in assessing the credibility of recovered memories of child sexual abuse: The importance of maintaining a case-specific focus.

In this article, the authors argue that a variety of psychological factors stand in the way of providing expert advice to the courts in terms of assessing the credibility of a complainant’s account of sexual abuse when there is a significant delay in reporting. These include difficulties in assessing (a) the complainant’s account of how he or she claims to have remembered or forgotten the abuse, (b) whether (and how) the claim of abuse originated within a therapeutic setting, and (c) the difficulty of generalizing from empirical evidence. It is argued that all of these issues can be more easily avoided if experts maintain a case-specific focus. In this article, the authors review both the psychological and legal controversies surrounding the false‐recovered memory debate, discuss how courts approach the admissibility and use of recovered memory testimony, and conclude that expert witnesses should carefully consider the above points before drawing general conclusions from the literature and applying them to individual cases.

Dispatch from the (un)civil memory wars

Over the last few years, our society has been immersed in a motley collection of “Memory Wars,” as they were called in a lengthy review of several books on recovered memory published in Scientific American (Schacter, 1995). The “memory war” theme was also used to title an editorial that appeared in Psychology Today magazine (Neimark, 1996). The editorialist wrote: “You’d think that memory would be the stuff of dry academia, but it turns out to be one of the most illuminating and terrifying stories of our time” (p. 6). And the “war” theme appeared in the title of a book that reprinted a sizzling pair of essays published previously in the New York Review of Books by Berkeley professor and Freud scholar, Frederick Crews (1995). In those essays, Crews identified a number of beliefs about human nature that he felt have been propagated by leaders of a well-meaning, but misguided, movement: that repression is the normal human response to trauma; that experiences in infancy produce long-term memories that can be accurately retrieved decades later; that adult psychological difficulties can be reliably ascribed to certain forgotten events in early childhood and not others; that sexual traumas are incomparably more susceptible to repression and the formation of neurosis than any other kind; that symptoms are themselves “memories” that can yield up the story of their origin; that dream interpretation, too, can disclose the repressed past; that memory retrieval is necessary for symptom removal; and that psychotherapists can confidently trace their clinical findings to the patient’s unconscious without allowing for the contaminating influence of their own diagnostic system, imparted directly or through suggestion (274).

The Misnomer of Freud's "Seduction Theory"

Sigmund Freud's of 1896 was buried without a name in 1897, less than two years after it appeared. process by which it acquired a name, seduction theory, and the role this name played in the history of psychoanalysis are essential parts of the legend-making in Freud's biography. label, bestowed half a century after publication, reflected two major rhetorical transformations. First, from a presented with highly general claims of infant sex abuse, assault, and trauma, the was repackaged as a of seduction. Second, from a reportedly based in actual, experience, followed by repressed memory, it was transformed into one of fantasy. name seduction theory has therefore operated as a misleading, strategic misnomer for the that Freud published in 1896. Freud announced his in three publications, referred to here in order of publication as the Paris paper,' the Berlin paper,2 and The Aetiology of Hysteria, published in Vienna.3 In his final publication the emphasis on trauma was greatest. In the space of five pages in the Standard Edition of Freud's works he used the word traumatic or traumatically fifteen times.4 Although

Datapoints: adolescents with substance abuse: are health plans missing them?

Back to table of contents Previous article Next article ColumnsFull AccessDatapoints: Adolescents With Substance Abuse: Are Health Plans Missing Them?Margaret T. Lee, Ph.D., Deborah W. Garnick, Sc.D., Kay Miller, B.A., and Constance M. Horgan, Sc.D.Margaret T. LeeSearch for more papers by this author, Ph.D., Deborah W. GarnickSearch for more papers by this author, Sc.D., Kay MillerSearch for more papers by this author, B.A., and Constance M. HorganSearch for more papers by this author, Sc.D.Published Online:1 Feb 2004https://doi.org/10.1176/appi.ps.55.2.116AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail This column examines whether health plans are adequately identifying adolescents with substance use problems. Three measures developed by the Washington Circle, a group focused on the development of substance abuse performance measures (1,2) (www.washingtoncircle.org), have been adapted for the 2004 Health Plan Employer Data and Information Set (www.ncqa.org). One measure—the identification rate—can be used to examine the extent to which private health plans are able to identify adolescent enrollees with substance use problems.We calculated this rate for adolescents using MarketScan, a database of private health plan claims for selected employers maintained by the MEDSTAT Group. About a quarter million adolescents were covered in 1997. The number of adolescents with any primary or secondary substance abuse claims during the year was divided by the member-years for adolescents aged 12 to 18.For enrolled adolescents, the overall identification rate was .5 percent (Figure 1)—.7 percent for males and .4 percent for females. We compared these results to the 6.8 percent rate of alcohol dependence or drug dependence—or both—obtained from a special analysis of a subset of adolescents covered by commercial insurance who were included in the 1998 National Household Survey on Drug Abuse (Harwood H, personal communication, July 2001). No meaningful variation was observed across health plan type.Several factors may contribute to the low rate. Primary care or other providers may fail to identify substance abuse because they lack adequate training in or incentives for screening and diagnosis. Stigma associated with the use of drugs or legal issues may make providers reluctant to record adolescents' substance abuse diagnoses.The low rate points to the urgent need to close the gap between the number of adolescents who need treatment and those who receive it. Steps needed include better training for primary care practitioners in recognition, early intervention, and referral. By making health plans accountable for identifying adolescents and for getting them into treatment quickly, a clear incentive is introduced for greater case finding.AcknowledgmentsThis research was supported by the Substance Abuse and Mental Health Services Administration and grant 5 P50 DA 10233 from the National Institute on Drug Abuse to the Brandeis/Harvard Center for Managed Care and Drug Abuse. The authors thank Mady Chalk, Ph.D., Sarah Wattenberg, L.C.S.W.-C., Frank McCorry, Ph.D., Doreen Cavanaugh, Ph.D., Pat Harrison, Ph.D., and Connie Weisner, Dr.P.H.Dr. Lee, Dr. Garnick, and Dr. Horgan are affiliated with the Schneider Institute for Health Policy of the Heller School for Social Policy and Management at Brandeis University 415 South Street, MS 035, Waltham, Massachusetts 02454-9110 (e-mail, [email protected]). Ms. Miller is with the MEDSTAT Group in Santa Barbara, California. Harold Alan Pincus, M.D., and Terri L. Tanielian, M.A., are editors of this column.Figure 1. Identification rate in private health plans for adolescents with substance use disorders compared with the rate derived from data from the NHSDAaa Respondents were classified as substance dependent if they met three of the six DSM-IV criteria on the 1998 National Household Survey on Drug Abuse (NHSDA) questionnaire. Items included questions about health and emotional problems associated with substance use, attempts to cut down, tolerance, withdrawal, and other symptoms.

Wife Abuse, Child Custody and Access in Canada

SUMMARY In Canada, custody and access decisions continue to be made on the basis of the highly discretionary “best interests of the child” test, with only one province having legislation that requires judges to take account of spousal abuse in making decisions about children. This article reports on a study of Canadian family law cases from 1997–2000 that had spousal abuse issues (N= 45). Judges tended not to grant custody to a man who has abused his partner if the woman's claims of abuse were accepted as valid, but routinely granted abusive men access to their children on an unsupervised basis. This is problematic as many of the factors which create a risk in awarding custody to a batterer may endanger the mother or child if there is unsupervised access. Canada is in the midst of a contentious process of reforming child custody and access laws. Legislation should make specific reference to spousal abuse as a factor in making child related decisions, including consideration of the effect of any custody or access order on the safety of children and victims of spousal abuse.

"I'm a Bit Concerned"--Early Actions and Psychological Constructions in a Child Protection Helpline

This article analyzes early actions in 50 calls reporting cases of abuse to a national child protection helpline in the UK (the National Society for the Prevention of Cruelty to Children Helpline, NSPCC). It focuses on the early turns in the caller's reason for call, in particular, a class of constructions in which the caller describes himself or herself as "concerned about x" (or similar). Analysis of the corpus of calls suggests concern constructions are canonical early elements of the reason-for-call sequence. Concern constructions (a) are oriented to a pre-move in the caller's reason for call, (b) project the unpacking of concerns in a way oriented to the NSPCC's institutional role, (c) attend to epistemological asymmetries between caller and call taker and remove the requirement for disaffiliative next actions such as asking for the basis of claims, (d) provide a way for the Child Protection Officer to take abuse claims seriously while not presupposing their truth, and (e) display an appropriate caller stance. These observations are supported by an analysis of deviant cases. The broader implications of this study for the relation between psychology, interaction, and institutions are discussed.

Munchausen Syndrome by Proxy: Identification and diagnosis

Child abuse claims the lives of three children daily in the United States; however, one form of child abuse frequently goes undiagnosed—the true incidence is not known. Munchausen Syndrome by Proxy (MSBP) is a hidden and deceitful abuse whereby a caretaker of a child, usually the mother, fabricates information concerning the child's health or intentionally makes the child ill for personal attention and psychologic gain. Because health care professionals are the child's first line of defense against MSBP, they must know all about the disorder to be able to identify MSBP and protect children from disability or death.

Comment on Bensel: “But the Bumblebee Flies Anyway, Doesn't It?”

“The American Ballot Box” is a most interesting exploration into the deep past of American electoral politics. Well-researched and argued, it provides examples of sometimes very funny interview sessions with nineteenth-century American voters. The basic data method here rests upon using congressional-election contest hearings as sources of information. The author does well, however, to remind us that by definition, election contests may have reflected “the dark side of the force,” so to speak, but also necessarily raised claims of fraud and other abuse by the losers. Naturally, the overwhelming majority of U.S. House elections in the nineteenth century were not contested. The strength of the method lies in the fact of contest itself, which permitted relatively searching inquiry into the conduct of elections, and thus revealed much about their organizational pattern that would be taken for granted (and hence not discussed or brought to light otherwise). But bias may be implicit in the method.

Unison: ‘investigate sexual abuse claims’

Unison: ‘investigate sexual abuse claims’

The International Criminal Court and the Political Economy of Antitreaty Discourse

This article examines U.S. opposition to the International Criminal Court (ICC) as a case study in how domestic and international politics shape discourse against new treaty-based legal obligations. When it comes to the ICC, official U.S. government discourse repeatedly alleges process-oriented shortcomings, particularly procedural due process problems and risks of prosecutorial abuse. This tendency to emphasize process-oriented arguments is borne out in a sample of public documents with dates between February 2001 and February 2003, where U.S. government officials made statements opposing U.S. participation in the ICC. Procedural due process and prosecutorial abuse claims account for about 80% of the lead arguments (that is, arguments developed in the most detail), and about 62% of the total arguments in the sample.Just as process arguments about domestic criminal law sometimes masquerade for positions about substantive law, the process arguments against the ICC appear to under-explain the vehemence of U.S. rejection of the court. The ICC's procedural protections for defendants tend to be comparable to those in the U.S., and it is not obvious that the court's prosecutor will be free from at least some legal, political, and economic forces that also impact U.S. prosecutors. Conversely, even if the court copiously observed procedural safeguards and the prosecutor only proceeded with the utmost fidelity to the substantive law, the underlying international law the court would enforce would still interfere with unfettered military discretion likely to be valued by a number of U.S. domestic constituencies.Despite their legalistic pedigree, the process-focused arguments and the underlying rejection of the court by the U.S. government appear to reflect the impact of international and domestic politics. A focus on procedure sounds marginally more principled to international audiences than a brute realist assertion that American interests are best served by keeping unfettered control of military decisions. The process arguments and rejection of the ICC exemplify the sort of discourse that can appeal to members of the public forming opinions about foreign policy that in turn shape more general evaluations of the government. Yet this comes with costs: It elides debate over the value of the brute realist position that American military power should be subject to few meaningful constraints, and instead makes it look like the most important question is about the procedural shortcomings of a court that is precisely meant to address the arbitrariness in international criminal justice that critics use to assail it.

Mentally Ill Workers Rarely Prevail in ADA Discrimination Claims, Survey Finds

Mentally Ill Workers Rarely Prevail in ADA Discrimination Claims, Survey Finds

A perfect symmetry? A study of retractors' experiences of making and then repudiating claims of early sexual abuse

Recent research has attempted to inform the false/recovered memory debate by examining the circumstances surrounding retractors' experiences of coming to make claims that they were abused. The limited available research that is currently available has been heavily criticised on the grounds that retractors' experiences do not qualify as reliable evidence because retractors themselves may simply be highly suggestible or unreliable witnesses. The present study sought to examine these, as yet unqualified, criticisms by comparing retractors' experiences of both recovering and retracting claims of abuse. Twenty self-reported retractors completed a 62-item questionnaire regarding their experiences of recovering and subsequently retracting claims to have been abused. Analysis indicated a consistent asymmetry between the processes of recovery and retraction; for the majority of respondents retraction was reported to have taken substantially longer than recovery, and to have involved much less social pressure. Furthermore, several factors were revealed that respondents reported to be more important than social pressure in leading them to question the validity of their abuse claims (such as, the experiential qualities and logical inconsistencies of the recovered abuse memories).

Introduction: Exposing Misinformation Concerning Child Sexual Abuse and Adult Survivors

SUMMARY This article introduces a special volume on misinformation about child sexual abuse. Despite extensive research findings on the long-term effects and consequences of child sexual abuse, misinformation on this topic is widespread. Several forces have worked to support and disseminate this erroneous information. Because it is difficult to comprehend the horror of sexual crimes against children, society's denial and disbelief have often unwittingly supported the agendas of those who want to discount or minimize the impact of these crimes. The media has also contributed to the aura of skepticism surrounding claims of sexual abuse and its mental health impact, and has reported favorably on controversial and unproven claims such as the “false memory syndrome”. In the hope of countering misinformation and thus raising the level of discourse to the engagement of real scientific issues, a number of well known and respected researchers and clinicians examine various facets of the problem.

Crisis or Creation? A Systematic Examination of False Memory Syndrome

SUMMARY In 1992, the False Memory Syndrome Foundation (FMSF), an advocacy organization for people claiming to be falsely accused of sexual abuse, announced the discovery of a new syndrome involving iatrogenically created false memories of childhood sexual abuse. This article critically examines the assumptions underlying “False Memory Syndrome” to determine whether there is sufficient empirical evidence to support it as a valid diagnostic construct. Epidemiological evidence is also examined to determine whether there is data to support its advocates' claim of a public health crisis or epidemic. A review of the relevant literature demonstrates that the existence of such a syndrome lacks general acceptance in the mental health field, and that the construct is based on a series of faulty assumptions, many of which have been scientifically disproven. There is a similar lack of empirical validation for claims of a “false memory” epidemic. It is concluded that in the absence of any substantive scientific support, “False Memory Syndrome” is best characterized as a pseudoscientific syndrome that was developed to defend against claims of child abuse.

The Perceptual Language of Credibility

Abstract This article describes a novel method of evaluating claims of sexual abuse in custody/visitation disputes wherein the wife is both the accuser and the alleged victim. The method relies on a perceptual bias for abuse imagery that characterizes the perceptual processing of Rorschach stimuli by women with histories of sexual abuse. Results demonstrated that abuse imagery was significantly related to the personal experience of sexual abuse (68.4% of women alleging marital sexual abuse and 77.8% of sexually traumatized women with a Post Traumatic Stress Disorder). By comparison, the incidence of abuse imagery was strikingly low (6.4%) among women whose exposure to sexual abuse stemmed from parenting a child alleging paternal sexual abuse. This custody sample was indistinguishable from a non-custody sample of women (7.9%) matched for a history of no sexual abuse. The findings support the premise that preoccupation with sexual abuse does not affect the perception of people who have not personally experienced sexual abuse. In balancing the charges and countercharges that permeate custody disputes, those investigating and evaluating claims of spousal sexual abuse may find perceptual information, that is unrelated to common knowledge, a valuable data source.

The Conundrum of Children, Confrontation, and Hearsay

Richard D. Friedman (*) I INTRODUCTION The adjudication of child abuse claims poses an excruciatingly difficult conundrum. The crime is a terrible one, but false convictions abhorrent. Often the evidence does not support a finding of guilt or innocence with sufficient clarity to allow a decision free of gnawing doubt. In many cases, a large part of the problem is that the prosecution's case depends critically on the statement or testimony of a young child. Even with respect to adult witnesses, the law of hearsay and confrontation is very perplexing, as anyone who has studied American evidentiary law and read Supreme Court opinions on the subject knows. Juxtaposing problems of hearsay and confrontation with those of child sexual abuse yields one of the most intractable problems that a system of criminal justice can face. II RESTRUCTURING THE GENERAL LAW OF CONFRONTATION AND HEARSAY I do not believe that our criminal justice system can reach a satisfactory resolution of the problems inherent in adjudicating claims of child abuse until it restructures the general law of confrontation and hearsay. (1) In Lilly v. Virginia, (2) I co-authored an amicus brief for the American Civil Liberties Union proposing a reconceptualization of the confrontation right. (3) Justice Breyer, one of the members of the plurality in that case, wrote a concurring opinion referring extensively to the brief and expressing considerable sympathy for the views advanced in it. (4) These views in many ways compatible with those of Justices Scalia and Thomas. (5) Thus, it is plausible that in the reasonably near future the Court will revamp the Confrontation Clause along the lines suggested in the amicus brief. The current doctrine depends largely on the Court's perception that hearsay law and the confrontation right are generally designed to protect similar values and stem from the same roots. (6) Thus, the Court has tended to meld the two, treating both as aimed at facilitating accuracy in truth-finding by weeding out unreliable evidence. With respect to out-of-court statements, therefore, the Court has given the confrontation right very little ambit independent of hearsay law. If a statement fits within a firmly rooted hearsay exemption, (7) then the Confrontation Clause is unlikely to pose an obstacle to admissibility. (8) As a result, whether a statement by a child alieging sexual abuse should be admitted at the trial of the alleged abuser often depends on whether the court deems the statement to fit within one of the hearsay exemptions listed in the Federal Rules, a list purportedly determined by considerations of reliability. (9) This approach is objectionable on numerous grounds. A. The Difficulties of Determining Reliability Reliability is very difficult to determine. To confirm this point, we need look no further than the current debate over the reliability of child witnesses. (10) Any attempt to sort out reliable from unreliable evidence must run aground. If the determination is made according to broad categories of evidence, the law will be too blunt--not only sweeping in many statements that not reliable, but also basing decisions on generalizations that may have little bearing on the particular case. If the determination is made case by case, it will not necessarily be any better. The determination will inevitably be very subjective, and it will be either effectively immune from appellate control or extremely demanding on appellate resources. As an example of how reliability testing does not work, consider the decision of the Court of Appeals for the Tenth Circuit on remand in United States v. Tome. The court held that a five-year-old girl's statements to pediatricians alleging that her father had sexually abused her more than a year before were within the hearsay exception. (12) Because the identity of the perpetrator was important information in determining whether there was a risk of sexually transmitted disease, the court concluded that the statements were made for purposes of medical diagnosis and treatment, and therefore reliable for purposes of the Confrontation Clause. …

Effects of managed care on programs and practices for the treatment of alcohol and drug dependence.

Managed care is affecting the organization and financing of treatment services for alcohol and drug dependence. This paper examines the effects of managed care on program operations including the use of clinical protocols, the administrative burden, information systems, staffing, and program consolidation. It also reviews the effects of managed care on system performance related to employer-sponsored health plans, state employee health plans, and Medicaid and other public plans. Our review of managed care's influences on the alcohol and drug abuse treatment system finds evidence of systemic reductions in access to inpatient care and increased reliance on outpatient services. Moreover, although analyses of behavioral health carve-outs often suggest increases in the use of outpatient care, evaluations of substance abuse claims report reductions in ambulatory utilization for the treatment of alcohol and drug dependence.

False confessions and false memories: a model for understanding retractors' experiences

The present paper examines reports by 'retractors' (i.e. adults who have retracted their earlier claims of childhood abuse) to explore suggestions in the literature of possible similarities between their experiences and the experiences of individuals who falsely confess to criminal acts. Despite concerns about the reliability of retractors' reports, these individuals provide valuable insight into the processes involved in making and then repudiating claims of abuse. The present analysis revealed similarities between the contexts in which retractors came to report that they were sexually abused and the contexts in which false confessions arise. Although caution must be taken in generalizing from these findings, these similarities indicate that models of false confession could serve as a useful basis for conceptualizing the processes involved in the development of claims of childhood sexual abuse that are subsequently retracted.