Evaluation Of Sexual Abuse Research Articles

Child Sexual Abuse.

1. Antonia Chiesa, MD* 2. Edward Goldson, MD* 1. *Pediatrics, University of Colorado School of Medicine, Children’s Hospital Colorado, Aurora, CO * Abbreviations: CDC: : Centers for Disease Control and Prevention HIV: : human immunodeficiency virus SANE: : Sexual Assault Nurse Examiner STI: : sexually transmitted infection 1. Clinicians should be aware that, in most cases, sexual abuse of a child is distinctly different from adult sexual assault. Usually there is no physical evidence of the abuse and delayed disclosure is common. 2. Developmental and behavioral histories are important components of a medical history for a sexual abuse diagnosis. Clinicians must be aware of normal sexual behaviors in children. The child’s developmental level also informs the approach to evaluation, including how much information can be obtained directly from the child. After completing this article, readers should be able to: 1. Review the epidemiology of child sexual abuse. 2. Recognize the history, signs, and symptoms of sexual abuse. 3. Recognize which patients require emergent evaluation and physical examination for sexual abuse or assault. 4. Describe the behavioral and emotional consequences of child sexual abuse. 5. Describe the normal process of disclosure. 6. Employ effective strategies for interviewing suspected victims of sexual abuse or assault. 7. Recognize that most children examined for sexual abuse have normal examination findings. 8. Discuss common abnormal anogenital findings associated with sexual abuse and differentiate them from those associated with accidental trauma and other medical conditions. 9. Plan appropriate collection of forensic evidence and laboratory evaluation during a sexual abuse concern. 10. Follow mandated reporting laws when there are suspicions of child sexual abuse. Child sexual abuse is one of the most challenging forms of child maltreatment encountered by pediatric clinicians. It is a highly emotional topic in our society, and although the legal and medical definitions appear to be relatively straightforward, it is very difficult to operationalize them in real-life circumstances. Social contexts affect awareness and cultural norms. High-profile cases with sports figures and clergy …

The evaluation of child sexual abuse in child advocacy center: one year experience of a single center

Objective: Child Advocacy Centers (CAC) are multidisciplinary centers that evaluate child sexual abuse (CSA) cases. In Turkey, CACs, first in Ankara, has been established all around the country. This study is conducted to evaluate the CSA cases’ demographic findings, admission types, diagnosis and outcomes in the first year of Izmir CAC. Methods: The data of 943 cases were evaluated retrospectively and 848 child diagnosed as CSA were accepted as the study group. Descriptive statistical analysis were performed. Results: The mean age of the study group was 14.1±3.3 with female/male ratio 5.73. The most common presentation type was sexual abuse due to peer relations of adolescent girls. The most frequent admission type was by law enforcement while the most common presentation by medical services was from psychiatry clinics. The 60% of the study group defined CSA with contact while 27% defined penetration. The perpetrators were frequently (60%) recognized persons before CSA, most of them were friend/boyfriends and darlings. The frequency of incest cases was 10.7%. The most frequent perpetrator of incest cases were fathers. The 99% of perpetrators were males in the study group while 100% in the incest group. Forty eight percent of the study group required forensic examination but the diagnostic value was 32%. Discussion: CACs are functional centers in evaluating child sexual abuse cases in a multidisciplinary approach. As the most common type of admissions is sexual abuse due to peer relations in adolescents, we suggest that preventive social works should focus on this issue.

Community Characteristics Associated With Seeking Medical Evaluation for Suspected Child Sexual Abuse in Greater Houston.

Child sexual abuse (CSA) affects over 62,000 children annually in the United States. A primary obstacle to the success of a public health prevention strategy is the lack of knowledge around community level risk factors for CSA. We evaluated community level characteristics for children seeking care for suspected CSA in the Greater Houston area for 2009. There was a total incidence rate of medical evaluations for suspected CSA of 5.9/1000 children. We abstracted the medical charts of 1982 (86%) children who sought a medical evaluation for suspected CSA at three main medical systems in the Greater Houston area for 2009. We evaluated 18 community level variables from the American Community Survey for the 396 zip codes these children lived in. The mean number of cases per Greater Houston zip code was 2.77 (range 0-27), with 62% of zip codes not having a case at any of the three sites surveyed. Zip codes with a higher than Houston average rate of vacant houses, never married females and unemployed labor force with high family poverty rate, were associated with an increased rate of children seeking care for suspected CSA. We demonstrated zip codes level characteristics which were associated with an increased rate of children seeking care for suspected CSA. Our modelling process and our data have implications for community based strategies aimed at improved surveillance or prevention of CSA. The process of identifying locally specific community level factors suggests target areas which have particular socioeconomic characteristics which are associated with increased rate of seeking CSA evaluations.

Diagnostic agreement when comparing still and video imaging for the medical evaluation of child sexual abuse

Still photo imaging is often used in medical evaluations of child sexual abuse (CSA) but video imaging may be superior. We aimed to compare still images to videos with respect to diagnostic agreement regarding hymenal deep notches and transections in post-pubertal females. Additionally, we evaluated the role of experience and expertise on agreement. We hypothesized that videos would result in improved diagnostic agreement of multiple evaluators as compared to still photos. This was a prospective quasi-experimental study using imaging modality as the quasi-independent variable. The dependent variable was diagnostic agreement of participants regarding presence/absence of findings indicating penetrative trauma on non-acute post-pubertal genital exams. Participants were medical personnel who regularly perform CSA exams. Diagnostic agreement was evaluated utilizing a retrospective selection of videos and still photos obtained directly from the videos. Videos and still photos were embedded into an on-line survey as sixteen cases. One-hundred sixteen participants completed the study. Participant diagnosis was more likely to agree with study center diagnosis when using video (p<0.01). Use of video resulted in statistically significant changes in diagnosis in four of eight cases. In two cases, the diagnosis of the majority of participants changed from no hymenal transection to transection present. No difference in agreement was found based on experience or expertise. Use of video vs. still images resulted in increased agreement with original examiner and changes in diagnostic impressions in review of CSA exams. Further study is warranted, as video imaging may have significant impacts on diagnosis.

A Retrospective Analysis of Children's Assessment Reports: What Helps Children Tell?

This paper explores a retrospective analysis of children's file data as a research method of gathering information on children's experiences of informal disclosure of child sexual abuse. This study extracted data from files where children were seen for a child sexual abuse evaluation in Ireland and the children were deemed to have given a credible account of abuse by the professionals concerned. A content analysis was conducted using themes identified in previously published research, based on direct interviews with children about their experiences of informal disclosure. The paper discusses the relative merits and limitations of this method, through reporting on the findings of the file analysis and comparing these findings with findings obtained from a smaller sub‐sample of this sample of children, who were interviewed about their experiences of disclosure. It is suggested that this method is worth exploring with a larger sample size which would enable statistical analysis and thus explore the predictive factors influencing early informal disclosure. Frontline services can contribute to the knowledge base on what helps children tell through service‐based research that uses data already collected from evaluation interviews with children, thus eliminating the need to interview children for research purposes. Copyright © 2015 John Wiley &amp; Sons, Ltd.‘A content analysis was conducted using themes identified in previously published research’Key Practitioner Messages Frontline professionals gather useful data on a daily basis on informal disclosures of child sexual abuse. Practitioners can contribute to the knowledge base on informal disclosure by systematically gathering information from service users. We need more information on what helps children tell. We therefore need to explore innovative methods of gathering such information directly from children in ways that do not rely on interviewing children repeatedly yet include the child's voice. ‘We need more information on what helps children tell’

A Nationwide Survey of Peer Review Practices in Child Maltreatment Teams

Medical evaluations for suspected child sexual abuse carry a significant medico‐legal burden and are often performed in a variety of clinical settings, by clinicians with different levels of expertise and experience. Peer review or professional practice evaluation is an important component for quality assurance. We surveyed 255 programmes which provided sexual abuse evaluations which were identified through queries with national child abuse professional organisations. We sought information on team composition and setting, patient population characteristics and each site's peer review process. Of the 129 responding programmes, 42 per cent (n = 44) reported having a written peer review process. There were no differences between practice types with regards to having a written peer review process, the percentage of cases reviewed, the documentation type reviewed or the percentage reporting an external review process. The majority of programmes (n = 89, 85%) reported that they review both chart and photo documentation during the peer review process. Our data support that most programmes involved in child maltreatment evaluations undergo some form of peer review, but there exists a large amount of heterogeneity in the process by which it occurs. Copyright © 2014 John Wiley &amp; Sons, Ltd.‘We surveyed 255 programmes which provided sexual abuse evaluations’Key Practitioner Messages: Peer review is an important process to ensure high quality of clinical practice. The majority (80%) of programmes which perform child sexual abuse evaluations reported performing some form of peer review. Most peer review involves both chart and photo documentation reviews. ‘Most peer review involves both chart and photo documentation reviews’

Child sexual abuse research knowledge among child abuse professionals and laypersons

The purposes of this study were to: (1) Assess child abuse professionals’ and nonprofessionals’ knowledge of scientific research findings that are relevant to forensic child sexual abuse (CSA) evaluations and (2) describe associations between child abuse professionals’ levels of research knowledge and their education and experience. An 18-item multiple-choice test was administered to 188 child abuse professionals and 457 nonprofessionals (undergraduate college students) in Brazil and the United States. The nonprofessionals’ average percent correct, M=44%, was not significantly different than what would be expected for random guessing (45%). The professionals’ average percent correct, M=55%, was higher than that of nonprofessionals and random guessing (both ps<.001). The average percent correct score for the US-sample psychologists, M=76%, was higher than the average score of the other professionals, M=51%, p<.001. Professionals’ educational level, as measured by the highest academic degree obtained, was positively associated with percent correct scores, Spearman's ρ=.46, p<.001. Controlling for educational attainment, professional experience, as measured by the total number of CSA evaluations performed, was weakly associated with percent correct scores, partial r=.15, p=.04. Percent correct scores were low for both nonprofessionals and professionals. Most of the participants in this study were uninformed or misinformed about scientific research findings that are important for conducting optimal forensic CSA evaluations and for making accurate judgments about the validity of sexual abuse allegations.

An important topic in medical education: Multidisciplinary approach to a sexual assault case in the emergency clinic

Alcohol related sexual violence is an important public health problem. However, there is a few research conducted on this problem in Turkey. The purpose of this case report is to compose a scientific approach in the view of literature. We report an alcohol related sexual assault case for presenting adequate approach to these cases according to current guidelines. The victim was 17 years old female adolescent diagnosed and treated in the emergency service. The patient was hospitalized in the Child and Adolescent Psychiatry Service after emergency treatment in the Pediatric Emergency Medicine and Intensive Care Unit. A review and discussion of alcohol related sexual assault case is presented, and also multidisciplinary diagnosis and treatment approach is offered for this entity. The blood alcohol level of the patient was 410 mg/dL, Glasgow coma scale (GCS) was seven and body temperature was 35°C in the emergency service. Whole body examination findings revealed physical assault and also genital examination findings confirmed sexual assault. It should be remembered that delay in diagnosis and treatment of cases may lead to significant health problems in the victims of sexual assault. Also assessing sexual assault cases, especially in emergency services needs to integrate assessments of different social and medical disciplines. Thus, latest guidelines for the evaluation of sexual abuse of children in emergency services must be learned by medical students and physicians. J. Exp. Clin. Med., 2014; 31:63-65

Chlamydia Infections in Children and Adolescents

1. Lorena M. Siqueira, MD, MSPH* 1. *Division of Adolescent Medicine, Miami Children’s Hospital, Miami, FL. * Abbreviations: CDC: : Centers for Disease Control and Prevention FDA: : Food and Drug Administration HIV: : human immunodeficiency virus LGV: : lymphogranuloma venereum MIF: : microimmunofluorescent MSM: : men who have sex with men NAAT: : nucleic acid amplification tests PID: : pelvic inflammatory disease STI: : sexually transmitted infection 1. The need for annual screening for chlamydia in sexually active adolescents and young adults is underrecognized because this infection is asymptomatic in most females (75%) and males (50%). 2. Difficulty in diagnosis arises from the range of possible symptoms at presentation of symptomatic infections and the type of testing that can be used in each situation. After completing this article the reader should be able to: 1. Recognize the spectrum of clinical manifestations of chlamydia infection in neonates, children, and adolescents. 2. Discuss the appropriate use of culture and nonculture diagnostic tests for chlamydia infections in various age groups. 3. List the current recommendations for screening and treatment of chlamydia infections. A 17-year-old girl presents with prolonged menstrual bleeding associated with severe menstrual cramping pain. Her menarche was at age 13 years. Subsequent menstrual cycles were monthly, lasting 5 days, with average flow associated with mild to moderate pain relieved by over-the-counter pain medications. The current cycle began a month ago and is associated with severe lower abdominal pain. She admits to sexual activity with one partner and uses condoms intermittently. On examination she is afebrile and in discomfort, with a heart rate of 120 beats per minute. She does not appear anemic and has good capillary refill. She has diffuse abdominal pain with significant tenderness in both the right lower and upper quadrants. Chlamydiae are small obligate, gram-negative, intracellular bacteria that contain both DNA and RNA and were formerly considered to be viruses. There are 3 species that are pathogenic to humans: Chlamydia trachomatis , Chlamydophilia pneumoniae, and Chlamydophilia psittaci . They fall within 2 genera in the family Chlamydiaceae . C trachomatis is in …

Is There a Place for Extended Assessments in Addressing Child Sexual Abuse Allegations? How Sensitivity and Specificity Impact Professional Perspectives

Using data from a survey of perceptions of 932 child welfare professionals about the utility of extended assessments, the researchers constructed a scale to measure respondents' views about sensitivity (ensuring sexually abused children are correctly identified) and specificity (ensuring nonabused children are correctly identified) in child sexual abuse evaluations. On average, respondents scored high (valuing sensitivity) on the sensitivity versus specificity scale. Next, the researchers undertook bivariate analyses to identify independent variables significantly associated with the sensitivity versus specificity scale. Then those variables were entered into a multiple regression. Four independent variables were significantly related to higher sensitivity scores: encountering cases requiring extended assessments, valuing extended assessments among scarce resources, less concern about proving cases in court, and viewing the goal of extended assessments as understanding needs of child and family (adjusted R2 = .34).

The Evaluation of Children in the Primary Care Setting When Sexual Abuse Is Suspected

This clinical report updates a 2005 report from the American Academy of Pediatrics on the evaluation of sexual abuse in children. The medical assessment of suspected child sexual abuse should include obtaining a history, performing a physical examination, and obtaining appropriate laboratory tests. The role of the physician includes determining the need to report suspected sexual abuse; assessing the physical, emotional, and behavioral consequences of sexual abuse; providing information to parents about how to support their child; and coordinating with other professionals to provide comprehensive treatment and follow-up of children exposed to child sexual abuse.

Acute Genital Ulcers in Nonsexually Active Young Girls: Case Series, Review of the Literature, and Evaluation and Management Recommendations

Acute genital ulcers rarely occur in nonsexually active young girls. When present, they can cause significant physical and emotional distress for the patient and her parents, and prompt an evaluation for sexual abuse and sexually transmitted diseases. With this review, we aim to further characterize acute genital ulcers in nonsexually active young girls by reviewing the medical records of patients with this disorder and to offer an approach to the diagnosis, evaluation, and treatment of acute genital ulcers based on our understanding and knowledge of this condition. We retrospectively review our understanding and knowledge of acute genital ulcers in nonsexually active girls at a pediatric hospital. A review of the recent literature on acute genital ulcers and a multidisciplinary approach to the diagnosis, evaluation, and treatment of acute genital ulcers are also presented. Twelve patients presented with acute genital ulcers, 11 of which were hospitalized for evaluation and pain management. Extensive work-up failed to reveal a specific infectious or autoimmune etiology in all but one patient, who was diagnosed with acute mycoplasma pneumonia. Acute genital ulcers in nonsexually active young girls likely represent a form of idiopathic vulvar aphthosis. Evaluation of a first episode of acute genital ulcers with mild prodromal symptoms should be limited. Treatment consists primarily of supportive care and symptom relief.

Development of standardized clinical training cases for diagnosis of sexual abuse using a secure telehealth application

ObjectivesThe training of physicians, nurse examiners, social workers and other health professional on the evidentiary findings of sexual abuse in children is challenging. Our objective was to develop peer reviewed training cases for medical examiners of child sexual abuse, using a secure web based telehealth application (TeleCAM). MethodsSixty de-identified cases developed by 2 child abuse pediatricians, were stratified by availability of information (minimal, moderate, comprehensive) for both positive and negative child sexual abuse findings. These cases were narrowed to a set of 30 cases through an expert peer review process using pediatricians with extensive expertise in the evaluation of child sexual abuse. A previously studied secure web-based telehealth application TeleCAM which contains a child abuse workflow, was used to develop, disseminate and review cases. A series of Free Margin agreement statistics are used to select those cases with the highest rates of agreement. A final set of 30 cases are stratified equally by availability of information and for both positive and negative findings. Mantel Haenszel Chi-square was used for trend analysis of the ordered categorical variables. ResultsThe highest degrees of inter-rater reliability was found in cases with moderate to comprehensive information. Cases with minimal data had poor kappa agreement indicating that availability of differing levels and types of information contribute to variability in diagnostic findings. ConclusionThese final cases will be further studied with medical examiners in various settings utilizing TeleCAM as the application for dissemination.

P-679 - Parental alienation - a seven year old girl with a long story in the brazilian court

Parental alienation is a form of psychological and emotional child abuse which generally is initiated after the divorce, when one parent (the guardian) starts to disqualify and demoralize the other parent (the alienated), trying to keep the child away from the last one and destroying basic emotional links between them. On the 26th of August 2010, the Brazilian Parliament ratified a law (Law nº 12.318) against parental alienation, which defines and punishes this act. To demonstrate that parental alienation is a major cause of distress for the child, independent of the evaluation of sexual abuse. Parental alienation can bring psychosomatic and psychiatric problems as well. To prevent “alienation” cases which can cause harmful effects in the child's life. Evalluation of a case report studied by Psychiatrists and Psychologists in Rio de Janeiro. A girl who was taken away from her father by her mother after the divorce, when she was 6 months old. The mother tried to avoid the father's contact with the child, alleging that he sexually abused the kid. Nowadays, the girl hates her father. It was not possible to conclude if the child was sexually abused or not. But it was clear that the girl was a victim of emotional and psychological abuse. A child's life can be devastated by parental alienation because of the “loss” of one parent and the negative effects in the development of emotional life. Severe penalties for the parents should be taken to prevent it.

Reliability of Professional Judgments in Forensic Child Sexual Abuse Evaluations: Unsettled or Unsettling Science?

In the absence of photographic or DNA evidence, a credible eyewitness, or perpetrator confession, forensic evaluators in cases of alleged child sexual abuse must rely on psychosocial or “soft” evidence, often requiring substantial professional judgment for case determination. This article offers a three-part rebuttal to Herman's (2009) argument that forensic decisions based on psychosocial evidence are fundamentally unreliable and that this conclusion represents settled science. The article also discusses the potentially adverse consequences of Herman's proposed reforms to forensic practice on child protection and prosecution efforts.

Conducting the Medical History

A key portion of the medical evaluation of child sexual abuse is the medical history. This differs from interviews or histories obtained by other professionals in that it is focuses more on the health and well-being of the child. Careful questions should be asked about all aspects of the child's medical history by a skilled, compassionate, nonjudgmental, and objective clinician. Often the diagnosis of sexual abuse is based only on the medical history. The history can be further understood by knowledge of how children are abused and their reactions to it. By addressing the child's and parent's concerns, reassurance can also be provided about what is normal and abnormal with the child's body.

Medical Evaluation of Suspected Child Sexual Abuse: 2011 Update

The medical evaluation of children with suspected sexual abuse includes more than just the physical examination of the child. The importance of taking a detailed medical history from the parents and a history from the child about physical sensations following sexual contact has been emphasized in other articles in the medical literature. The examination is important, however, and medical providers who examine children need to be aware of published research on findings in nonabused children, studies of healing of injuries, and studies documenting the association between sexual contact and the diagnosis of sexually transmissible infections in children. This article reviews the current approach to interpreting findings in children who may have been sexually abused and why additional research is needed.

P1-S2.28 Sexually transmitted infections in sexually abused children and adolescents in Ibadan, Nigeria

BackgroundSexual assault is a violent crime that affects men, women, and children of all ages. Sexually transmitted infections (STIs) may be transmitted during sexual assault. This study was aimed at...

Forensic child sexual abuse evaluations: Assessing subjectivity and bias in professional judgements

Objectives Evaluators examining the same evidence often arrive at substantially different conclusions in forensic assessments of child sexual abuse (CSA). This study attempts to identify and quantify subjective factors that contribute to such disagreements so that interventions can be devised to improve the reliability of case decisions. Methods Participants included 1106 professionals in the field of child maltreatment representing a range of professional positions or job titles and years of experience. Each completed the Child Forensic Attitude Scale (CFAS), a 28-item survey assessing 3 forensic attitudes believed to influence professional judgments about CSA allegations: emphasis-on-sensitivity (i.e., a focus on minimizing false negatives or errors of undercalling abuse); emphasis-on-specificity (i.e., a focus on minimizing false positives or errors of overcalling abuse); and skepticism toward child and adolescent reports of CSA. A subset of 605 professionals also participated in 1 of 3 diverse decision exercises to assess the influence of the 3 forensic attitudes on ratings of case credibility. Results Exploratory factor analysis identified 4 factors or attitude subscales that corresponded closely with the original CFAS scales: 2 subscales for emphasis-on-sensitivity and 1 each for emphasis-on-specificity and skepticism. Attitude subscale scores differed significantly by sample source (in-state trainings vs. national conferences), gender, years of experience, and professional position, with Child Protective Service workers unexpectedly more concerned about overcalling abuse and more skeptical of child disclosures than other professionals—a pattern of scores associated with an increased probability of disbelieving CSA allegations. The 3 decision exercises offered validation of the attitude subscales as predictors of professional ratings of case credibility, with adjusted R 2s for the three exercises ranging from .06 to .24, suggesting highly variable effect sizes. Conclusions Evaluator disagreements about CSA allegations can be explained, in part, by individual differences in 3 attitudes related to forensic decision-making: emphasis-on-sensitivity, emphasis-on-specificity, and skepticism toward child reports of abuse. These attitudes operate as predispositions or biases toward viewing CSA allegations as likely true or likely false. Several strategies for curbing the influence of subjective factors are highlighted including self-awareness of personal biases and team approaches to assessment.

Medico-Legal evaluation of child sexual abuse over a six-year period from 2004 to 2009 in the Suez Canal area, Egypt

BackgroundSex crimes are complex and multidimensional; over the past few decades, child sexual abuse has gained public attention and become one of the most high-profile crimes. Since the 1970s, sexual abuse of children and child molestation has increasingly been recognized as deeply damaging to children and unacceptable for society as a whole. MethodsThis is a retrospective and prospective study evaluating sexual assault against children in the Suez Canal area in Egypt from 2004 to 2009, assessing the prevalence of sexual assault and associated factors among its victims. Examination was carried out in the Medico-Legal department of Ministry of Justice, Suez Canal area including Ismailia, Port-Said, El-Suez, and North Sinai cities. ResultsThere were 128 cases in the age range of 5–18years (53.9% girls and 46.1% boys). Of these cases, 88.3% were between 10 and 18years old, and 11.7% were between 5 and 10years old. Those living in urban areas comprised 83.6% of the cases, and 16.4% lived in rural areas. Intra-familial assailants comprised 13.3% of the cases, while 86.7% were extra-familial to the victims. From the intra-familial cases, 35.3% of the cases were incest against girls and 29.4% cases were intra-familial sodomy against boys. In 63.1% of the cases, the assailants were unknown to the victim; 18.7% reported sexual assault by more than one attacker, and 7.1% of cases reported sexual assault combined with physical assault. The most frequently reported types of abuse were anal assault (52.3%) followed by incomplete vaginal penetration (36%) and complete vaginal penetration (7.8%). Mixed assaults − vaginal and anal – occurred in 3.9% of the cases. Sexual assault was made under verbal threat in 39% of the cases, while sexual assault was made under armed threats in 3.9% of cases. In 34.4%, examination of the victims was done within 3weeks of the assault; in 26.6% of cases, examination was done within 2weeks; in 14.8%, examination of the child was done after 1month, and in 10.2% of cases, examination was done within 2–4days of the crime. ConclusionsDoctors and other health professionals should be aware of the high prevalence rate of child abuse and its potential for initial and long-term deleterious outcomes.