Predictors of non-offending caregiver support in cases of child sexual abuse.

BACKGROUND: In cases of child sexual abuse (CSA), a supportive non-offending caregiver (NOC) is important for the child's overall well-being and adjustment. NOC support is also predictive of CSA cases moving forward to prosecution. Limited research has studied CSA case factors in relation to NOC supportive behaviors across numerous support dimensions. OBJECTIVE: We investigated what case details predicted four different dimensions of caregiver support. PARTICIPANTS AND SETTINGS: In this secondary analysis, a sample of 500 CSA cases from four prosecutors' offices in one New England state from 2009 to 2013 were randomly selected and reviewed. METHOD: This study used regression analysis to test 13 case characteristics (e.g., disclosure of abuse, NOC's relationship to perpetrator) as predictors of NOC support dimensions: belief of victim, support of prosecution, protection of victim, and whether a child protective services neglect report was filed against the caregiver. RESULTS: When the perpetrator was their romantic partner, the NOC was less likely to protect and believe the child victim, yet more likely to support prosecution. NOCs were more likely to demonstrate belief when the child disclosed to them first. CONCLUSION: Our findings reveal the importance of the key case factors that are predictive of NOC support. This is the first study to examine these many case factors in relation to these four dimensions of support. Knowledge of these predictors can play an important role in better understanding the complexity of NOC support predictors and facilitating interventions designed to enhance such support.

Longitudinal predictors of children's self-blame appraisals among military families reported for family violence.

BACKGROUND: Although children's self-blame appraisals are recognized as important sequelae of child victimization that contribute to subsequent adjustment problems, little is known about the factors that predict their development and longitudinal course. OBJECTIVE: The current study examines the stability and longitudinal predictors of children's self-blame appraisals among a sample of children reported for family violence. PARTICIPANTS AND SETTING: Children (N = 195; 63 % female) aged 7 to 17 years (Mage = 12.17) were recruited as part of a longitudinal assessment of families referred to the United States Navy's Family Advocacy Program due to allegations of child physical abuse, sexual abuse, or intimate partner violence. METHODS: Children completed assessments on self-blame at 3 time points (baseline, 9-12 months, and 18-24 months) and baseline measures of their victimization experience, caregiver-child conflict, and depression. RESULTS: In univariate analyses, victimization that involved injury (r = 0.29, p < .001), the number of perpetrators (r = 0.23, p = .001), the number of victimization types (r = 0.32, p < .001), caregiver-child conflict (r = 0.36, p < .001), and depression (r = 0.39, p < .001) were each positively associated with baseline self-blame. When examined in a single longitudinal multilevel model, results indicated only caregiver-child conflict (b = 0.08, p = .007) and baseline depression (b = 0.06, p = .013) predicted increases in self-blame. CONCLUSION: Findings suggest clinicians and researchers may consider assessment of victimization characteristics, caregiver-child relationships, and depression symptoms to identify children most at risk for developing self-blame appraisals.

Predictors of Prosecutorial Decisions in Reports of Child Sexual Abuse.

A retrospective examination of 500 child sexual abuse reports to prosecutor's offices analyzed case progress and predictors of attrition, including details about alleged perpetrator(s), victim(s), their families, and other case characteristics. Less than one in five cases proceeded to prosecution. For the full sample, we describe all outcomes and differentiate prosecutors' decisions to (a) intake/close, (b) investigate/close, or (c) prosecute; these stages comprise a 3-level dependent variable. Because it is important to understand which variables are associated with progress to each stage, we examined unique predictors of the decision to "investigate," and to "prosecute." Our multivariate analyses examine 325 cases with a perpetrator aged 16 and older. Caregiver support and perpetrator age were significant predictors across all outcome variables, while other factors were barriers to the "prosecute" decision only. Results highlight the complexities of case characteristics that are important at different stages of prosecutorial decision-making and inform future interventions.

It All Just Piles Up: Challenges to Victim Credibility Accumulate to Influence Sexual Assault Case Processing.

The underreporting of sexual assault is well known to researchers, practitioners, and victims. When victims do report, their complaints are unlikely to end in arrest or prosecution. Existing research on police discretion suggests that the police decision to arrest for sexual assault offenses can be influenced by a variety of legal and extra-legal factors particularly challenges to victim credibility. Although extant literature examines the effects of individual behaviors on police outcomes, less is known about how the accumulation of these behaviors, attributions, and characteristics affects police decision making. Using data collected from the Los Angeles Police Department and Sheriff's Department, we examine one police decision point-the arrest to fill this gap in the literature. First, we examine the extent to which the effects of potential challenges to victim credibility, based on victim characteristics and behaviors, influence the arrest decision, and next, how these predictors vary across circumstances. Specifically, we examine how factors that challenge victim credibility affect the likelihood of arrest in sexual assault cases where the victim and offender are strangers, acquaintances, and intimate partners.

Changing attitudes about being a bystander to violence: translating an in-person sexual violence prevention program to a new campus.

Bystander approaches to reducing sexual violence train community members in prosocial roles to interrupt situations with risk of sexual violence and be supportive community allies after an assault. This study employs a true experimental design to evaluate the effectiveness of Bringing in the Bystander™ through 1-year post-implementation with first-year students from two universities (one rural, primarily residential; one urban, heavily commuter). We found significant change in bystander attitudes for male and female student program participants compared with the control group on both campuses, although the pattern of change depended on the combination of gender and campus.

Encouraging responses in sexual and relationship violence prevention: what program effects remain 1 year later?

Colleges and universities are high-risk settings for sexual and relationship violence. To address these problems, institutions of higher education have implemented prevention programs, many of which train students as potential bystanders who can step in to help diffuse risky situations, identify and challenge perpetrators, and assist victims. The impact of bystander sexual and relationship violence prevention programs on long-term behavior of bystanders has remained a key unanswered question for those who seek to offer the most effective programs as well as for policy makers. In this study, the researchers experimentally evaluated the effectiveness of the Bringing in the Bystander® in-person program. Participants were 948 1st-year college students of whom 47.8% were women and 85.2% identified as White (15% also identified as Hispanic in a separate question) between the ages of 18 and 24 at two universities (one a rural, primarily residential campus and the other an urban, highly commuter campus) in the northeastern United States. To date, this is the first study to have found positive behavior changes as long-lasting as 1 year following an educational workshop focusing on engaging bystanders in preventing sexual and relationship violence. Even so, many questions remain to be answered about prevention and intervention of this type. More prospective research is needed on bystander-focused prevention of these forms of violence to help understand and better predict the complicated relationships both between and among the attitudes and behaviors related to preventing sexual and relationship violence. In this regard, we make specific recommendations for designing and evaluating programs based on our findings relating to the importance of moderators, especially two key understudied ones, readiness to help and opportunity to intervene.

Patterns of multiple victimization among maltreated children in Navy families.

The current study examined the cumulative risk associated with children's exposure to multiple types of parent-inflicted victimization. The sample was comprised of 195 children who were 7 to 17 years old (64.1% female and 48.2% non-White) at the time of referral to the United States Navy's Family Advocacy Program due to allegations of sexual abuse, physical abuse, or parental intimate partner violence. We conducted an exploratory latent class analysis to identify distinct subgroups of children based on lifetime victimization. We hypothesized that at least 2 classes or subgroups would be identified, with 1 characterized by greater victimization and poorer outcomes. Results indicated that 3 classes of children best fit the data: (a) high victimization across all 3 categories, (b) high rates of physical abuse and witnessing intimate partner violence, and (c) high rates of physical abuse only. Findings indicated that the high victimization class was at greatest risk for alcohol and substance use, delinquent behavior, and meeting criteria for posttraumatic stress disorder (PTSD) and/or depression 1 year later (odds ratio = 4.53). These findings highlight the serious mental health needs of a small but significantly high-risk portion of multiply victimized children entering the child welfare system.

Patient's self-evaluation of two education programs for age-related skin changes in the face: a prospective, randomized, controlled study.

BACKGROUND: An interactive software program (HOYS) has been developed utilizing a database of digital images depicting various aspects and degrees of aging of exposed skin across seven geographic regions, representing a total of 35 facial and extrafacial subregions. A five-point photonumeric rating scale, which portrays age-related skin changes across five decades for each of these subregions, underpins this patient-based interactive self-assessment program. Based on the resulting outputs from this program, an individualized treatment prioritization list is generated for each region where significant differences between the patient's chronological and esthetic ages exist. This provides guidance for the patient and the treating physician on treatment options. METHODS: To evaluate the utility of HOYS in the clinic, relative to education programs currently used in Australian private esthetic clinics, a total of 95 esthetically-orientated patients were enrolled in a prospective, randomized, controlled, multicenter study. RESULTS: Compared with a prospective cohort of patients completing a standard education program commonly utilized in Australian esthetic clinics, patients receiving the HOYS education program reported greater empowerment through improved knowledge of specific age-related skin changes. This was associated with a clearer understanding of treatment options available to them, and a perceived ability to participate in the selection of the treatments potentially administered to improve their appearance. These differences between the two education groups were highly significant. CONCLUSION: Patients completing the HOYS patient education program have an improved understanding of age-related changes to exposed skin of their face, neck, décolletage, and hands. Due to the patient-specific nature of the program, these patients perceive a greater role in the deciding which esthetic treatments should be subsequently administered to enhance their appearance, through an improved understanding of the rationale for these treatments and indeed how they should be prioritized to achieve the best outcome for them.

Posttraumatic stress symptom trajectories in children living in families reported for family violence.

The present study examined latent class trajectories of posttraumatic stress disorder (PTSD) and associations between demographics, prior trauma, and reason for referral on class membership. Children ages 7-18 (n=201) were recruited for participation in the Navy Family Study following reports to the U.S. Navy's Family Advocacy Program (FAP). Initial interviews were conducted 2-6 weeks following FAP referral, with follow-ups conducted at 9-12, 18-24, and 36-40 months. Growth mixture modeling revealed two latent class trajectories: a resilient class and a persistent symptom class. Relative to youth in the resilient class, participants in the persistent symptom class were more likely to be older and to report exposure to a greater number of trauma experiences at Time 1.

The complexity of trauma types in the lives of women in families referred for family violence: Multiple mediators of mental health.

Responding to calls for further research about the impact of multiple types of trauma across the life span, this study examines the interconnections among types of trauma in childhood and adulthood in a convenience clinical sample of 283 women obtaining social services for family violence. In particular, variables including family of-origin dysfunction and other childhood risk factors, relationship victimization in adulthood, and the presence of adult resources were examined as mediators of links between child maltreatment and adult mental health symptoms. Variables were assessed at different time points, 3 years apart. Path analysis revealed that the conceptual model of multiple pathways between childhood family violence exposure and adult outcomes fit the data well. In particular, the link between child maltreatment and adult trauma symptoms was mediated by more proximal adult sexual and intimate partner violence and its association with childhood risk markers (e.g., negative family environment) and decreased markers of resources. This link was not significant for a more general index of mental health symptoms in adulthood.

Women's voices on recovery: a multi-method study of the complexity of recovery from child sexual abuse.

OBJECTIVE: The current study was exploratory and used multiple methods to examine patterns of stability and change in resilient functioning across 7 years of early adulthood. Second, qualitative data were used to examine in greater detail survivors' own narratives about correlates of healing. METHOD: This study was longitudinal and used both structured and open-ended interviews. Eighty women with documented hospital records of child sexual abuse were interviewed at two time points 7 years apart in early adulthood. Structured interviews including investigator-based questions and standardized measures of trauma exposure and functioning were conducted. A subset of 21 survivors participated in in-depth, open-ended interviews about coping with sexual abuse. RESULTS: Quantitative findings showed patterns of both stability and change on an index of resilient functioning across multiple domains in the 7 years between interviews with 76% of participants showing less than a one standard deviation change in scores. Lower resilience was associated with exposure to additional trauma between the two interviews (r=-.44) while positive functioning was related to social role satisfaction and positive sense of community. Qualitative data permitted examination of the dynamic quality of recovery over time including the role of "turning points" across the lifespan. CONCLUSIONS: The findings extend previous studies of resilience in the examination of how it changes over the course of one segment of the life cycle. This study supports recent work that described resilience as a non-linear process and further highlights factors including the role of re-traumatization, social supports, and opportunities for making new choices that may be important correlates of recovery processes among sexual abuse survivors over time.

Relational outcomes of childhood sexual trauma in female survivors: a longitudinal study.

This longitudinal study examines the effects of childhood sexual abuse (CSA) on the intimate and marital relationships of adult survivors from a sample composed primarily of African American women. In addition, the authors explore the protective role of maternal support. Interview data are collected on 136 women with documented histories of CSA who indicate the quality and nature of their current marital relationships and other interpersonal connections. Results suggest that CSA survivors with poor maternal attachment are more likely to enter into marital or cohabiting relationships. However, more severe sexual trauma in childhood correlates with greater marital dissatisfaction. Good maternal attachment during childhood has a negative main effect on adult interpersonal problems and a buffering effect on the relationship between abuse and marital dissatisfaction. These data can help guide future research on the adult relational outcomes of female CSA survivors, especially among minority populations.

Researcher-advocate collaborations to end violence against women: toward liberating methodologies for action research.

This article relies on literature from the field and on research conducted by the National Violence Against Women Prevention Research Center to describe the difficulties encountered in collaborations between researchers and advocates working on the prevention of violence against women. The article summarizes guidelines for collaboration that have been suggested by many researchers and advocates, and it makes the claim that a feminist approach to liberating methodologies for action research is needed to increase the likelihood of successful collaborations.

Childhood sexual abuse: a gender perspective on context and consequences.

Literature on gender and child sexual abuse (CSA) has highlighted patterns of similarity and difference among survivors and the need for further research. This study relied on gender analysis of 128 women and 69 men, obtained through an examination of childhood hospital records, to further examine gender differences in mental health outcomes among abuse survivors and correlates of mental health outcomes including professional help seeking, family environment, and other trauma exposure. Overall, men and women were similar in the context and consequences of CSA. The role of the characteristics of CSA and contextual variables in explaining variance in mental health for 106 male victims and nonvictims was also examined. Among male participants, number of incidents of sexual abuse, injury at the hands of a caregiver, and exposure to other traumas significantly explained higher levels of an array of mental health symptoms. Implications for future research are discussed.

The impact of complex trauma and depression on parenting: an exploration of mediating risk and protective factors.

The current study examined (a) maternal depression as a mediator between mothers' complex trauma exposure and parenting difficulties and (b) protective factors within a sample of adult survivors of complex child and adult trauma. Participants were a sample of 152 women selected from 174 women interviewed in the third wave of a longitudinal study of a hospital sample of girls. The women in the current study represent a subsample that includes all participants who had given birth to a child. Measures included assessments of women's own trauma history and parenting outcomes. Higher rates of trauma exposure were related to decreased parenting satisfaction, reports of child neglect, use of physical punishment, and a history of protective service reports. These links were partially mediated by the relationship between trauma exposure and increased maternal depression. Exploratory analyses were also conducted to examine protective factors for fewer parenting problems within a further subsample of trauma survivors.

Mentoring college-age women: a relational approach.

Despite the popularity of mentoring programs, the relational dimension of mentoring has not been elucidated. Traditional conceptions of mentoring may exclude factors that are particularly important for women and girls, thus limiting the efficacy of mentoring programs for female adolescents. We suggest that the presence of relational qualities in the mentoring relationship (e.g., empathy, engagement, authenticity, and empowerment) strongly influences the success of mentoring in the lives of young women. In this study, we use a promising new measure of mentoring, the Relational Health Index - Mentor, to explore the impact of relational aspects of mentoring in female college students. We found that mentoring relationships high in relational qualities were associated with higher self-esteem and less loneliness

Re-traumatization among adult women sexually abused in childhood: exploratory analyses in a prospective study.

The current exploratory study examined a variety of risk factors related to re-traumatization, defined broadly, in a prospective sample of women who were sexually abused in childhood. Eighty women, who were part of a larger longitudinal study of the effects of child sexual abuse, were interviewed at three points in time: in childhood and at two points in early adulthood. Risk factors were measured at the second interview and used to predict reported trauma exposure between interviews two and three. Given theoretical arguments for differences in risk factors based on ecological context, analyses were conducted separately for married and unmarried women. Situational and intrapersonal risk factors such as homelessness and depression were predictive of re-traumatization risk while reported social support satisfaction was a protective factor. Reports of trauma exposure between interviews two and three were related to mental health symptoms.