Motivational Interviewing: Preparing People for Change

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Adverse Childhood Experiences: Expanding the Concept of Adversity.

The empirical basis for the child sexual abuse accommodation syndrome (CSAAS), a theoretical model that posits that sexually abused children frequently display secrecy, tentative disclosures, and retractions of abuse statements was reviewed. Two data sources were evaluated: retrospective studies of adults’ reports of having been abused as children and concurrent or chart-review studies of children undergoing evaluation or treatment for sexual abuse. The evidence indicates that the majority of abused children do not reveal abuse during childhood. However, the evidence fails to support the notion that denials, tentative disclosures, and recantations characterize the disclosure patterns of children with validated histories of sexual abuse. These results are discussed in terms of their implications governing the admissibility of expert testimony on CSAAS. Although it is widely acknowledged that the sexual assault of children is a major societal concern, it is not known how many children are victims of sexual abuse in the United States (Ceci & Friedman, 2000). There are two major reasons for this lack of data. First, present estimates of the incidence of child sexual abuse (CSA) are primarily based on reports received and validated by child protection agencies. These figures, however, do not reflect the number of unreported cases or the number of cases reported to other types of agencies (e.g., sheriff’s offices) and professionals (e.g., mental health diversion programs). Second, the accuracy of diagnosis of CSA is often difficult because definitive medical or physical evidence is lacking or inconclusive in the vast majority of cases (Bays & Chadwick, 1993; Berenson, Heger, & Andrews, 1991), and because there are no gold standard psychological symptoms specific to sexual abuse (Kendall-Tacket, Williams, & Finkelhor, 1993; Poole & Lindsay, 1998; J. M. Wood & Wright, 1995). Given these limitations of medical and psychological evidence, children’s statements typically represent the central evidence for judging the occurrence of

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DISCLOSURE OF CHILD SEXUAL ABUSE What Does the Research Tell Us About the Ways That Children Tell

This article presents psychometric characteristics of the UCLA PTSD Reaction Index for DSM IV (PTSD-RI) derived from a large sample of children and adolescents (N = 6,291) evaluated at National Child Traumatic Stress Network centers. Overall mean total PTSD-RI score for girls was significantly higher as compared with boys. Age-related differences were found in that overall mean total PTSD-RI scores and within sex groups were higher among those aged 7-9 years and 16-18 years. There were no significant differences in mean total PTSD-RI scores across racial/ethnic groups. The PTSD-RI total scale displayed good to excellent internal consistency reliability across age ranges, sex, and racial/ethnic groups (α = .88-.91). Correlations of PTSD-RI scores with PTS subscale scores on the TSCC-A for the entire sample and within sex, age, and ethnic/racial groups provided evidence of convergent validity, although not discriminant validity. In contradistinction to previously reported 4-factor models, an exploratory factor analysis revealed 3 factors that mostly reflected the underlying dimensions of PTSD in DSM IV. PTSD-RI scores were associated with increased odds ratios for functional/behavior problems (odds ratio [OR] = 1-1.80). These findings are striking in light of the wide range of trauma exposures, age, and race/ethnicity among subjects.

Psychometric Properties of the UCLA PTSD Reaction Index: Part I

The published literature regarding reactions of nonoffending parents to the sexual abuse of their child is reviewed. Research suggests that mothers generally believe their children's allegations, either totally or in part. Although the majority of mothers are supportive/protective, a substantial number are not. Even mothers who are generally supportive and protective often exhibit inconsistent and ambivalent responses. Studies examining factors that predict parental belief support, and protection have failed to yield consistent results. Few studies have examined nonoffending fathers' reactions following disclosure. Both nonoffending mothers and fathers often experience significant distress following their children's allegations. Parental support is consistently associated with the adjustment of sexually abused children. Few studies have examined interventions targeting nonoffending parents, although two series of well-designed studies suggest that cognitive-behavioral treatment that combines parent and child interventions may lead to better adjustment in both the child and the parent. Implications for mental health professionals are provided.

Reactions of Nonoffending Parents to the Sexual Abuse of their Child: A Review of the Literature

Children and adolescents who are exposed to traumatic events are helped by numerous child-serving agencies, including health, mental health, education, child welfare, first responder, and criminal justice systems to assist them in their recovery. Service providers need to incorporate a trauma-inform

Creating trauma-informed systems: Child welfare, education, first responders, health care, juvenile justice.

A subset of children referred due to suspected sexual abuse require more than one interview for professionals to reach an opinion about the veracity of allegations. The National Children's Advocacy Center's forensic evaluation model was designed for that specific group of children. The multisite study of the model reported here followed a 2-year pilot study. Professionals in 12 states adopted the model and collected data for 2 years on a total of 147 participants. In 44.5% of the cases, a credible disclosure was obtained, with 73% of these cases supported in the legal system. The forensic evaluation procedure yielded clear information to be used in child protection and prosecutory decisions in 64% of the cases (combining cases with credible disclosures and abuse unlikely findings). Finally, the study examined the effects of the length of the evaluation and of the case and child characteristics on evaluation outcomes.

Extended forensic evaluation when sexual abuse is suspected: A multisite field study

This article describes an extended forensic evaluation model, designed and piloted at the National Children's Advocacy Center (NCAC). The design and rationale of the NCAC forensic evaluation model are described. Outcomes achieved by using the model for 2 years are documented. Also described is a multisite research project, which is currently under way, that involves more than 30 Children's Advocacy Centers across the United States. This project will further test the efficacy of the model and refine its practice.

Extended Forensic Evaluation When Sexual Abuse is Suspected: A Model and Preliminary Data:

This paper will provide information on a recent Breakthrough Series Collaborative (BSC) conducted by the National Child Traumatic Stress Network on Using Trauma-Informed Child Welfare Practice to Improve Foster Care Placement Stability. Information on this particular BSC will be provided, followed by initial findings gathered from an evaluation of the BSC and metrics gathered by each of the nine participating teams throughout the BSC process. Specific trauma-informed promising strategies adopted by teams are presented along with recommendations for next steps.

Promising practices and strategies for using trauma-informed child welfare practice to improve foster care placement stability: a breakthrough series collaborative.

Charles Wilson

Papers

Creating trauma-informed systems: Child welfare, education, first responders, health care, juvenile justice.

Extended forensic evaluation when sexual abuse is suspected: A multisite field study

Extended Forensic Evaluation When Sexual Abuse is Suspected: A Model and Preliminary Data:

Promising practices and strategies for using trauma-informed child welfare practice to improve foster care placement stability: a breakthrough series collaborative.

Decision Making in Complex Environments