CHILD MALTREATMENT IDENTIFICATION, PART II: Sexual Abuse and Exploitation

1. CHILD MALTREATMENT IDENTIFICATION, PART II: Sexual Abuse and Exploitation California Common Core Training Version 1.25

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 1980’s. • “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 child’s 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 children’s 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 child’s 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 county’s 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 Elements:Emotional 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 Elements:Emotional Distress Anxiety-related indicators • Obsessive cleanliness • Self-mutilating or self-stimulating behaviors • Changed eating habits (anorexia, overeating, avoiding certain foods)

33. Behavioral Elements:Emotional 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 one’s 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 caregiver’s 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 child’s 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 child’s pediatrician did an exam, that is sufficient. • Myth

38. A View From The Shadows Johnny’s Story

39. Sgroi’s 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 Sgroi’s Stages and Summit’s Child Sexual Abuse Accommodation Syndrome in Johnny’s 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), cont’d 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), cont’d 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 children’s denial of abuse during formal questioning. • Many unanswered questions about children’s disclosure patterns remain, and further multivariate research is warranted.

45. Olafson & Lederman (2006), cont’d Additional factors that affect children’s 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. 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 Why don’t moms believe?

48. Why don’t 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 isn’t right, but doesn’t ask • Recognizes potentially abusive behaviors, acts to reduce risk or intervene

49. Why don’t 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 don’t look or act the way you’d 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