Using rapport building to improve information yield when interviewing adolescents: A systematic review and call for research.

BACKGROUND: Adolescents frequently experience and witness violence and crime, yet very little research has been conducted to determine how best to question these witnesses to elicit complete and accurate disclosures. OBJECTIVE: This systematic review integrated scientific research on rapport building with child and adult witnesses with theory and research on adolescent development in order to identify rapport building techniques likely to be effective with suspected adolescent victims and witnesses. METHOD: Four databases were searched to identify investigations of rapport building in forensic interviewing of adolescents. RESULTS: Despite decades of research of studies including child and adult participants, only one study since 1990 experimentally tested techniques to build rapport with adolescents. Most rapport strategies used with children and adults have yet to be tested with adolescents. Tests of these strategies, along with modifications based on developmental science of adolescence, would provide a roadmap to determining which approaches are most beneficial when questioning adolescent victims and witnesses. CONCLUSIONS: There is a clear need for research that tests what strategies are best to use with adolescents. They may be reluctant to disclose information about stressful or traumatic experiences to adults due to both normative developmental processes and the types of events about which they are questioned in legal settings. Rapport building approaches tailored to address adolescents' motivational needs may be effective in increasing adolescents' reporting, and additional research testing such approaches will provide much-needed insight to inform the development of evidence-based practices for questioning these youth.

Forensic interviewers' difficulty with the birthday narrative.

BACKGROUND: Narrative practice increases children's productivity in forensic interviews, and one recommended topic is the child's last birthday, though interviewers have raised concerns about its productivity. STUDY 1 OBJECTIVE: Study 1 surveyed forensic interviewers' use of and attitudes about the birthday narrative. PARTICIPANTS AND SETTING: Participants included 170 forensic interviewers who subscribed to a webinar promoting use of the birthday narrative (Mage = 43 years, SD = 10.2, 94 % female). RESULTS: Over half (55 %) of interviewers reported that they rarely/never asked about children's birthdays, and non-users were especially likely to view the birthday narrative as never/rarely productive. Although interviewers viewed memory difficulties as more likely to occur with the birthday narrative than other practice topics (the child's likes, the child's day), non-users did not view memory difficulties, reluctance, generic reports, or religious objections as especially problematic. Open-ended responses identified negative experiences with the birthday as an additional concern, and interviewers' recommended wording of the prompts suggested suboptimal questioning strategies. STUDY 2 OBJECTIVE: Study 2 assessed the use of the birthday narrative in forensic interviews. PARTICIPANTS AND SETTING: The sample included 350 forensic interviews with 4- to 12-year-old children (Mage = 8.85, SD = 2.59). RESULTS: Only 4 % of children failed to recall substantive information if interviewers persisted, though another 11 % failed when interviewers stopped persisting. Invitations were more effective than other question types, especially among older children. 21 % of children mentioned a negative detail during their narrative. CONCLUSIONS: Interviewers' skepticism about the birthday narrative may be due to suboptimal questioning and sensitivity to occasional failures and negative information.

Children's Elaborated Responses to Yes-No Questions in Forensic Interviews About Sexual Abuse.

Children tend to answer yes-no questions with unelaborated "yes" and "no" responses, but the types of details likely omitted from unelaborated answers have not been explored. This study examined 379 4- to 12-year-olds' answers to yes-no questions in forensic interviews about CSA (N = 11,187), focusing on age differences in elaborated responses. As expected, older children elaborated more frequently than younger children. Our novel categorization of elaboration types revealed that although there were no age differences in children's use of nominal corrections (correcting a label), or in emphatic negations (giving forceful denials), older children were more likely to give narrative elaborations (providing additional narrative information), wh-elaborations (answering implicit wh-questions), and qualified elaborations (avoiding potentially misleading implications of unelaborated "yes" and "no" responses). The results suggest that children's developing understanding of the implied meaning of questions and responses helps to explain age differences in elaborative responses to yes-no questions.

Initial Medical Assessment of Possible Child Sexual Abuse: History, History, History.

Primary care professionals (PCPs) can play a valuable role in the initial assessment of possible child sexual abuse (CSA), an all too prevalent problem. PCPs, however, are often reluctant to conduct these assessments. The goal of this paper is to help PCPs be more competent and comfortable playing a limited but key role. This is much needed as there may be no need for further assessment and also because of a relative paucity of medical experts in this area. While some children present with physical problems, the child's history is generally the critical information. This article therefore focuses on practical guidance regarding history-taking when CSA is suspected, incorporating evidence from research on forensic interviewing. We have been mindful of the practical constraints of a busy practice and the role of the public agencies in fully investigating possible CSA. The approach also enables PCPs to support children and their families.

Appellate Review of Child Sexual Abuse Convictions: The Importance of Character Evidence.

This study examined the role of character evidence and other issues in criminal appeals of child sexual abuse (CSA) convictions. Character evidence includes uncharged acts and character witnesses who testify to another's reputation or opinion and is offered to prove an individual's propensities. Examining 168 appellate court opinions reviewing CSA convictions between 2005 and 2015 in Maricopa County, Arizona, we found that when specific types of evidence were at issue, they were most often character evidence issues (49%). However, appellate courts virtually never reversed convictions (n = 5), and when defendants did obtain relief, the reduction in charges or in sentences was minor. Of the small number of opinions that were published (n = 4), all focused on character evidence, including the single case reviewed by the Arizona Supreme Court. However, close examination of the published cases suggested they effected only modest change.

Successful Criminal Prosecutions of Sex Trafficking and Sexual Abuse of Minors: A Comparative Analysis.

Despite increased awareness of sex trafficking of minors in the U.S., prosecution of traffickers remains difficult, in part because of victim uncooperativeness. There are questions about how that uncooperativeness is expressed, whether it is evident in successfully prosecuted cases, and whether it is unique to trafficked minors or it emerges in similar age victims of sexual abuse. To provide insight relevant to these questions, we compared appellate opinions in two types of successfully prosecuted criminal cases: sex trafficking and sexual abuse of adolescent victims. In the trafficking opinions, victims were rarely described as disclosing on their own or as knowing their trafficker before the victimization. The opinions also often alluded to the trafficking victims' uncooperativeness and delinquency history, and frequently mentioned electronic evidence and prosecution experts. The sexual abuse opinions, in contrast, tended to suggest that victims' own disclosures initiated the case, perpetrators were known and trusted adults, and caregiver support during the case was common. Finally, the sexual abuse opinions never explicitly mentioned victim uncooperativeness or electronic evidence and rarely mentioned expert testimony or delinquency. The different characterizations of the two case types highlight the need for improved education concerning effective prosecution of sex crimes against minors.

Child Witnesses Productively Respond to "How" Questions About Evaluations but Struggle With Other "How" Questions.

Child interviewers are often advised to avoid asking "How" questions, particularly with young children. However, children tend to answer "How" evaluative questions productively (e.g., "How did you feel?"). "How" evaluative questions are phrased as a "How" followed by an auxiliary verb (e.g., "did" or "was"), but so are "How" questions requesting information about method or manner (e.g., "How did he touch you?"), and "How" method/manner questions might be more difficult for children to answer. We examined 458 5- to 17-year-old children questioned about sexual abuse, identified 2485 "How" questions with an auxiliary verb, and classified them as "How" evaluative (n = 886) or "How" method/manner (n = 1599). Across age, children gave more productive answers to "How" evaluative questions than "How" method/manner questions. Although even young children responded appropriately to "How" method/manner questions over 80% of the time, specific types of "How" method/manner questions were particularly difficult, including questions regarding clothing, body positioning, and the nature of touch. Children's difficulties lie in specific combinations of "How" questions and topics, rather than "How" questions in general.

Attorneys' Questions and Children's Responses Referring to the Nature of Sexual Touch in Child Sexual Abuse Trials.

Eliciting clear descriptions of sexual body parts and abusive touch in child sexual abuse trials is challenging because of children's immaturity and embarrassment. This study examined references to sexual body part knowledge and sexual touch in attorneys' questions and 5- to 10-year-old children's responses (N = 2,247) in 113 child sexual abuse trials. Regardless of children's age, attorneys and children primarily used unclear colloquialisms to refer to sexual body parts. Questions asking children to name sexual body parts elicited more uninformative responses than questions about the function of sexual body parts. In turn, questions about the function of sexual body parts were more likely to increase the specificity of body part identifications than questions about the location of sexual body parts. Attorneys predominantly used option-posing (yes-no and forced choice) questions to ask about sexual body part knowledge, the location of touch, the method or manner of touching, skin-to-skin contact, penetration, and how the touching felt. Generally, wh- questions were no more likely than option-posing questions to elicit uninformative responses, and consistently elicited more child-generated information. The results question the legal assumption that children's uninformative responses when testifying about sexual abuse should be overcome by asking option-posing questions.

Elaborations and Denials in Children's Responses to Yes-No Any/Some Questions in Forensic Interviews.

This study examined 379 4- to 12-year-old children's answers to any/some and other yes-no questions in forensic interviews about sexual abuse (N = 10,041). Yes-no questions that include the terms any/some (e.g., "Did he say anything?") often implicitly ask for elaboration when the answer is yes ("What did he say?"). However, children may give unelaborated responses to yes-no questions, fail to recognize implicit requests, and falsely respond "no." As predicted, children gave more wh- elaborations in response to any/some questions than other yes-no questions, but younger children elaborated less often than older children. Also as predicted, children responded "no" more often to any/some questions than to other yes-no questions, and more often to "any" than to "some" questions. "No" responses were also more common when children were asked potentially vague anything/something questions and else/other/different questions. The results highlight the potential risks of asking children any/some questions.

Streamlining orthopaedic trauma surgical care: do all patients need medical clearance?

INTRODUCTION: Preoperative medical optimization is necessary for safe and efficient care of the orthopaedic trauma patient. To improve care quality and value, a preoperative matrix was created to more appropriately utilize subspecialty consultation and avoid unnecessary consults, testing, and operating room delays. Our study compares surgical variables before and after implementation of the matrix to assess its utility. METHODS: A retrospective review of all orthopaedic trauma cases 6 months before and after the use of the matrix (2/2021-8/2021) was conducted an urban, level one trauma centre in collaboration with internal medicine, cardiology, anaesthesia, and orthopaedics. Patients were separated into two cohorts based on use of the matrix during the initial orthopaedic consultation. Logistic regressions were performed to limit significant differences in comorbidities. Independent samples t-tests and Chi-squared tests were used to compare means and proportions, respectively, between the two cohorts. RESULTS: In total, 576 patients were included in this study (281 pre- and 295 post-matrix implementation). Use of the matrix resulted in no significant difference in time to OR, LOS, readmissions, or ER visits; however, it resulted in 18% fewer overall preoperative consults for general trauma, and 25% fewer pre-operative consults for hip fractures. Older patients were more likely to require a consult regardless of matrix use. When controlling for comorbidities, patients with renal disease were at higher risk for increased LOS. CONCLUSION: Use of an orthopaedic surgical matrix to predict preoperative subspecialty consultation is easy to implement and allows for better care utilization without a corresponding increase in complications and readmissions. Follow-up studies are needed to reassess the relationships between matrix use and a potential decrease in ER to OR time, and validate its use.

Suppositional Wh-Questions About Perceptions, Conversations, and actions are More Productive than Paired Yes-No Questions when Questioning Maltreated Children.

Forensic interviewers are taught to pair yes-no questions with open-ended requests for recall in order to reduce the likelihood that they will be misled by false "yes" responses. However, yes-no questions may elicit false "no" responses. Questioning 112 6- to 11-year-old maltreated children about three innocuous events (outside activities, yesterday, last birthday), this study compared the productivity of paired yes-no questions about perceptions, conversations, and actions involving the hands and mouth (e.g., "Did you say anything?") with wh-questions (e.g., "What did you say?"). The wh-questions presupposed that children had content to provide, but did not specify that content. Children were twice as likely to deny content and half as likely to provide novel information when interviewers asked them yes-no questions. Younger children were more inclined than older children to deny content and give unelaborated "yes" responses. The results support further research into the potential for suppositional wh-questions to increase child witnesses' productivity.

Novel Forms of Reluctance Among Suspected Child Sexual Abuse Victims in Adolescence.

Adolescents tend to be neglected in research examining child sexual abuse (CSA) interviews, yet are often said to be particularly reluctant. This study examined reluctance among 119 10- to 17-year-old females questioned about suspected CSA (n = 25,942 responses), utilizing a scheme identifying previously overlooked types of reluctance in commercially sexually exploited (CSE) youth. In contrast to the CSE youth in a prior study, in which 26% of responses were reluctant, only 8% of CSA victims' responses expressed reluctance. Reluctance was unrelated to age, abuse characteristics, and don't know (IDK) responding. Greater reluctance (but not IDK responding) was related to disclosure of fewer characteristics of abuse. Virtually all youth (93%) had disclosed prior to the interview, in contrast to previous studies examining reluctance among adolescent victims of internet-initiated sexual abuse and CSE. The way in which abuse is discovered may better explain reluctance than the age of the alleged victims.

Pseudotemporal Invitations: 6- to 9-year-Old Maltreated Children's Tendency to Misinterpret Invitations Referencing "Time" as Solely Requesting Conventional Temporal Information.

Forensic interviewers ask children broad input-free recall questions about individual episodes in order to elicit complete narratives, often asking about "the first time," "the last time," and "one time." An overlooked problem is that the word "time" is potentially ambiguous, referring both to a particular episode and to conventional temporal information. We examined 191 6-9-year-old maltreated children's responses to questions about recent events varying the wording of the invitations, either asking children to "tell me about" or "tell me what happened" one time/the first time/the last time the child experienced recent recurrent events. Additionally, half of the children were asked a series of "when" questions about recurrent events before the invitations. Children were several times more likely to provide exclusively conventional temporal information to "tell me about" invitations compared to "tell me what happened" invitations, and asking "when" questions before the invitations increased children's tendency to give exclusively conventional temporal information. Children who answered a higher proportion of "when" questions with conventional temporal information were also more likely to do so in response to the invitations. The results suggest that children may often fail to provide narrative information because they misinterpret invitations using the word "time."

A review of open pelvic fractures with concurrent genitourinary injuries.

INTRODUCTION: Open pelvic fractures (OPFs) are uncommon but potentially lethal traumatic injuries. Often caused by high energy blunt trauma, they can cause severe injury to abdominal and pelvic structures. We sought to conduct a review of the literature in order to ascertain the rates of genitourinary injury and vaginal laceration after OPF and the rates of resulting infection and mortality. METHODS: A review of PubMed was conducted to identify studies reporting the rates of genitourinary injury from OPF. Study characteristics, patient characteristics, and outcomes were collected. The data were pooled, and descriptive statistics were obtained. RESULTS: Eight studies encompassing 343 patients were included. Average age was 35.1 years (10-85.9), 28% were female, and the average Injury Severity Score was 26.5 (4-75). 95.5% of patients had a blunt mechanism of injury. Motor vehicle collision (23.9%), motorcycle accident (19.7%), and pedestrian struck (19.3%) were the most common etiologies. Overall mortality and infection rates were 31.2% and 18.7%, respectively. 19.7% of patients suffered an injury to the genitourinary system, and 32.4% of females sustained a vaginal laceration. DISCUSSION: OPFs have the potential for extremely high morbidity and mortality. While much research has been done to prevent early mortality from hemorrhage, there is comparatively little research into late mortality stemming from infection and sepsis. Intravenous antibiotics are the mainstay of treatment, and local antibiotics usage has been encouraged. In patients with a vaginal laceration, it is important to provide antibiotic coverage for vaginal flora.

The Utility of the Birthday Prompt in Narrative Practice with Maltreated and Non-maltreated 4- to 9-year-old Children.

Forensic interviewers are encouraged to elicit a practice narrative from children in order to train them to answer free recall questions with narrative information. Although asking children about their last birthday has been recommended, concerns have been raised that many children will have nothing to report. This study asked 994 4- to 9-year-old maltreated and non-maltreated children to recall their last birthday. Although a fair number of children initially failed to recall information (9%), virtually all children recalled information with persistent encouragement (99%). Younger children and maltreated children were less responsive and spoke less, but nevertheless, 93% of the youngest children (4-year-olds) and 97% of maltreated children recalled information with persistent encouragement. The results suggest that children's failures to recall information about birthdays are predominantly attributable to a failure to provide additional support.

Do children unintentionally report maltreatment? Comparison of disclosures of neglect versus sexual abuse.

BACKGROUND AND AIMS: Children's initial reports often play a key role in the identification of maltreatment, and a sizeable amount of scientific research has examined how children disclose sexual and physical abuse. Although neglect constitutes a large proportion of maltreatment experiences, relatively little attention has been directed toward understanding whether and how children disclose neglect. The overarching aim of the present study was to document this process by comparing disclosure patterns in cases of neglect to those in cases of sexual abuse. METHOD: Redacted jurisdiction reports (N = 136) of substantiated dependency cases of neglect (n = 71) and sexual abuse (n = 65) in 4- to 17-year-olds were coded for why maltreatment was suspected, and for children's perceived awareness and disclosure of the maltreatment. RESULTS: Neglect was most often initially suspected via contact with emergency services (e.g., police, emergency medical services), whereas sexual abuse was most often initially suspected as a result of children's statements. Children evidenced greater perceived awareness of sexual abuse than neglect and were more likely to disclose the former in their first investigative interview. Perceived awareness was further associated with a higher likelihood of children's statements initiating discovery of maltreatment and disclosing in the first investigative interview. CONCLUSIONS: Children may benefit from greater knowledge about their needs for safety, supervision, and provision in the home, which could increase the likelihood they would disclose neglect. Such, in turn, could lead to earlier interventions for children and families.

Young children's understanding of the epistemic and deontic meanings of ask and tell.

The verbs ask and tell can be used both epistemically, referring to the flow of information, and deontically, referring to obligations through polite requests or commands. Some researchers suggest that children's understanding of deontic modals emerges earlier than their understanding of epistemic modals, possibly because theory of mind is required to understand epistemic modals. In the current study, 184 children aged 3-6 years were presented with vignettes depicting epistemic and deontic asking and telling and were asked whether the speaker asked or told, followed by first-order theory-of-mind tasks. An emergence of both epistemic and deontic understanding was found at 5 years of age, and both were correlated with children's theory-of-mind understanding. These findings are consistent with arguments that both epistemic and deontic understanding implicate theory-of-mind awareness and provide insight into the developmental trajectory of children's understanding.

Foster youth's placement preferences: The roles of kin, siblings, and age.

BACKGROUND: Debates exist regarding whether foster youth should be asked about their placement preferences following removal, with only youth aged 12 years and older at times assumed legally competent to provide input. OBJECTIVES: The present study evaluated whether placement-related factors known to predict youth's well-being also shape their placement preferences and whether preferences differ between youth below and above the age at which they are considered legally competent to provide input. METHOD: Data (N = 1033, ages 6-17 years, 54 % female) were obtained from NSCAW-I. Youth were asked open- and closed-ended questions about their placement preferences. RESULTS: Among youth removed for shorter periods, placement with kin was related to a greater preference for their current placement (RRR = 0.31, p < .001) and desire for permanency in that placement (OR = 1.95, p = .005) relative to youth placed with non-kin. However, youth removed for longer periods (e.g., a year) were similar in their desires for their current placement to be permanent regardless of whether they were living with kin or non-kin caregivers. Among younger youth, placement with siblings (RRR = 0.42, p = .015) was linked to a preference for their current placement. Racial match between youth and their non-kin caregiver was unrelated to their placement preferences. CONCLUSIONS: Findings revealed that both younger and older youth's placement preferences were shaped by factors objectively linked to youth's well-being and thus align with best practices in placement decisions. The paper discusses the importance of asking youth as young as 6 years about their placement preferences and offers suggestions for social service and legal professionals regarding questioning strategies.

4- to 15-year-old children's misinterpretation of invitations asking "about the time" as requests for temporal information in forensic interviews.

BACKGROUND: Forensic interviewers are taught to ask children invitations using the word "time" to refer to a specific episode (e.g., "Tell me about the last time he touched you."). However, children may interpret the word "time" as requesting conventional temporal information rather than narrative information. OBJECTIVE: We examined the rates at which children misinterpreted invitations containing the word "time," comparing invitations asking "about" an episode to invitations asking what "happened" during an episode. PARTICIPANTS: This study examined 827 forensic interviews of children aged 4 to 15 (Mage = 8.1 years) in cases of suspected sexual abuse. METHODS: We identified 1405 invitations using the word "time," and coded them for whether they asked "about" or what "happened." Children's responses were coded for whether they gave exclusively conventional temporal information, expressed temporal ignorance or uncertainty, requested clarification, or gave a don't know response. RESULTS: Children responded to About invitations with higher rates of conventional temporal information (11%) than Happened invitations (6%, p < .001). Children were also more inclined to express uncertainty about temporal information when asked About invitations (p = .04). In a third of the cases where children exhibited misunderstanding, interviewers failed to clarify their intentions. CONCLUSIONS: Forensic interviewers can reduce children's unresponsiveness to invitations by using Happened invitations that overcome the ambiguity associated with "time."