The experience of childhood sexual abuse: An exploratory description of psychological and adaptive functioning in Canadian men.

BACKGROUND: Childhood sexual abuse (CSA) affects a number of men yet knowledge gaps remain around comprehensively describing psychological and adaptive outcomes for this population. OBJECTIVE: Examine how a Canadian sample of men with and without CSA histories compares on broader areas of psychological and adaptive functioning. PARTICIPANTS AND SETTING: This exploratory study included 109 adult men aged 25-60 years who were grouped according to whether they experienced CSA (n = 69) or not (n = 40). Participants were recruited from Ottawa, Ontario, Canada. METHOD: Using a multi-method approach, we conducted an exploratory and comprehensive examination of how CSA contributes to various areas of psychological (e.g., depression, anxiety, stress, dissociation, anger, PTSD) and adaptive functioning (e.g., friendship quality, employment) using self-report and clinician-administered measures. RESULTS: CSA men were an average of 8.5 years old at abuse onset. Most (62.3 %) had disclosed their CSA experience, waiting an average of 13.6 years before disclosure. After controlling for covariates (i.e., other types of maltreatment, non-maltreatment adversities, education, income), results indicated a significant association between CSA and men's psychological functioning, but not their adaptive functioning. CONCLUSIONS: Findings highlight the importance of broadening our understanding of how the experience of CSA, controlling for important covariates, can contribute to the well-being of men in order to better respond to their psychological needs.

Teachers' Responses to Child Maltreatment.

Purpose: Teachers play an important role in detecting and reporting child maltreatment by virtue of their extensive contact with children. Current research, while limited, shows a tendency among teachers to under-detect and under-report various forms of child abuse and neglect. Methods: Using data from a pilot evaluation of child maltreatment training for teachers, we examined teachers' self-reported behaviours for different forms of maltreatment. Participants included 45 experienced teachers from a large urban centre in the province of Ontario (Canada) who rated their likelihood of, and rationale for, detecting and reporting maltreatment based on four case vignettes. Results: Accuracy rates for detection and reporting were highest for sexual abuse (95% and 93%), followed by neglect (87% and 75%), emotional abuse (86% and 70%), and physical abuse (58% and 27%). Differences in detection and reporting rates were only significant between physical abuse and other maltreatment types (sexual abuse and neglect for detection; sexual abuse, neglect, and emotional abuse for reporting), with accurate detection and reporting rates being significantly lower for physical abuse. Teachers stated that the physical abuse vignette lacked convincing evidence of child maltreatment. Further, many teachers indicated that additional information was needed to determine whether the vignette represented physical abuse and, as such, was reportable. Conclusion: Our findings suggest the need for more targeted interventions to improve teachers' decision-making with potential child maltreatment scenarios, especially for physical abuse, so that children who are experiencing maltreatment may be more accurately detected and reported to child protection.

Evaluation of a Trauma-Informed Parenting Program for Resource Parents.

Child maltreatment impacts many young people involved in the child welfare system, and it is important that the resource parents supporting these youth have knowledge and skills in trauma-informed care. The current study is a preliminary evaluation of the Resource Parent Curriculum (RPC), an in-service, 8-module, group-based parenting program developed by the National Child Traumatic Stress Network. Youth and caregiver outcomes were examined by way of a quasi-experimental design that included 22 resource parents in the experimental group and 21 in the waitlist control group and involved baseline, post-program, and 2-month follow-up assessments. For learning outcomes, RPC resulted in improvements in resource parents' knowledge and beliefs about trauma-informed parenting. While not statistically significant, potential effects included improvements in resource parents' tolerance of challenging youth behaviors and parenting self-efficacy. For behavioral outcomes, several non-significant potential effects were noted, including improvements in resource parents' attachment relationships with their youth and increased social supports. This study was the first to evaluate RPC using a quasi-experimental design within a Canadian context and through a virtual delivery. Findings highlighted several benefits of the program and resource parents' ongoing training needs.

The brain at rest: Exploratory Neurophysiological Findings Among Men With Histories of Childhood Sexual Abuse.

Purpose: There is a lack of research on childhood sexual abuse (CSA) experienced by men, with even less research examining long term neurophysiological repercussions. This study explored the neurophysiology of the brain at rest to examine the influence of CSA on resting state functional connectivity (RSFC) into adulthood. Methods: RSFC was examined with functional magnetic resonance imaging (fMRI) within the default mode, salience and limbic networks in men with CSA histories, with and without post-traumatic stress disorder (PTSD; CSA + PTSD n = 7, CSA-PTSD n = 9), and men without a CSA history nor PTSD (n = 13). Results: CSA + PTSD participants had increased functional connectivity (FC) in the medial prefrontal cortex (mPFC) from the default mode network seed compared to participants with CSA-PTSD. Both CSA groups showed significantly less FC in the striatal-thalamic circuits of the salience network than the control group. Similarly, the robust FC between the bilateral amygdalae and the mPFC that was notable in control participants, was not exhibited in participants who experienced CSA with or without PTSD histories. Conclusions: These findings demonstrate that intrinsic neurophysiological differences in limbic, salience and default mode network connectivity are apparent even during a resting state between the groups of participants. This is preliminary evidence of long-term neurophysiological effects of CSA in men with PTSD, and even in those without. Importantly, these findings can validate the lived experiences of males with CSA histories and guide researchers and clinicians to potential avenues to support their well-being.

Traumatic Autobiographical Memories: Preliminary fMRI Findings Among Men With Histories of Childhood Sexual Abuse.

Childhood sexual abuse (CSA) is associated with autobiographical memory (AM) disturbances. AM is important for future thinking, sense of self, and coping with negative emotions. CSA is under-researched among men, with research examining long-term neural correlates limited even further. This study explored the neural correlates of re-experiencing traumatic/negative memories to examine the influence of CSA on AM into adulthood. Fifteen males who experienced CSA, with and without posttraumatic stress disorder (PTSD; CSA+PTSD, n = 6; CSA-PTSD, n = 9) and control males without CSA histories nor PTSD (n = 11) completed a script-driven imagery paradigm during functional magnetic resonance imaging (fMRI). Males with CSA histories, with and without PTSD, processed their negative autobiographical memories with less activation compared to control males. The CSA+PTSD group of males had less activation in the left superior occipital, left superior parietal and left parahippocampal gyri compared to control participants. The CSA-PTSD group had reduced activation in the same regions to a lesser extent. This study provides preliminary empirical evidence to suggest CSA impacts AM for traumatic experiences, and the impact is notable even for men who experienced CSA but do not have PTSD. This study highlights the need for more research with men who have experienced CSA, so that, we can fully understand the neural correlates of emotional memories, and better support the mental health and continued wellness of men who experienced CSA.

Emotion Regulation and Mental Health among Men with Childhood Sexual Abuse Histories.

Childhood sexual abuse (CSA) is a form of child maltreatment which has been increasingly recognized as a common experience among men. Research on male CSA remains under-developed but suggests many negative mental health impacts. The current study examined the link between mental health outcomes and different emotion regulation strategies among 69 adult men. Men completed measures on their current mental well-being, and participated in a clinical interview about emotion regulation strategies used to manage memories about their sexual victimization. Results indicated that the most frequently used emotion regulation strategies were expressive suppression, rumination, and cognitive avoidance. For perceived effectiveness, men identified cognitive avoidance, self-medication, and behavioral avoidance as being most helpful in managing their CSA-related distress. Finally, greater use of deliberate self-harm, rumination, and behavioral avoidance was associated with more internalizing difficulties, while greater use of deliberate self-harm and self-medication was linked with more externalizing difficulties. Greater perceived efficacy of positive reappraisal was associated with fewer externalizing behaviors. Although these findings require replication through larger mixed-methods studies, they suggest the importance of incorporating emotion regulation strategies into interventions aimed at improving mental well-being among men with CSA histories.

Trauma-informed attitudes in residential treatment settings: Staff, child and youth factors predicting adoption, maintenance and change over time.

BACKGROUND: Little is known about the benefits of implementing trauma-informed care (TIC) training programs for child welfare workers serving in out-of-home treatment settings, or about how staff, child and youth characteristics affect adoption of favorable attitudes towards TIC. OBJECTIVE: This study aimed to understand how attitudes towards TIC changed over time for child welfare workers receiving training and monthly supervision sessions. PARTICIPANTS AND SETTING: Child welfare workers (n = 429) serving juveniles mandated to protection or offender units (ages = 3-20 years), across 11 child protection agencies in Quebec, Canada. METHODS: Participants completed the ARTIC-35 at pre-training, 6 months post-training, and 1 year follow-up. Multilevel mixed effect regression models were fit to examine outcomes for all subscales. RESULTS: Participants reported small improvements in attitudes towards TIC at post-training and 1 year follow-up for subscales related to problematic child/youth behavior (ß = 0.23-0.32, p's < 0.001). Multilevel modeling revealed that age group (adolescent), unit gender (boys) and legal mandate (offender) predicted higher pre-training TIC ratings for staff in management versus frontline positions across three subscales related to problematic child/youth behavior (ß = 0.77-0.93, p's < 0.05) and two subscales related to trauma work and support needs (ß = 0.66/0.84, p's < 0.05). CONCLUSIONS: Results extend previous research demonstrating an association between TIC training and improved attitudes towards TIC over time, and highlight specific contexts in which frontline staff may experience more difficulty applying TIC-based principles than colleagues in management positions.

The influence of emotion on working memory: Exploratory fMRI findings among men with histories of childhood sexual abuse.

BACKGROUND: Childhood maltreatment can have detrimental consequences on individual well-being and cognitive functioning. One type of childhood maltreatment that remains stigmatized and under-researched among men is child sexual abuse (CSA). Research examining the neurophysiological consequences of CSA in males is limited even further. OBJECTIVE: To provide preliminary insight into the neural basis of the impact of CSA during two working memory tasks. PARTICIPANTS AND SETTING: Men with CSA histories, with and without post-traumatic stress disorder (PTSD; CSA + PTSD n = 7, mean age = 45; CSA-PTSD; n = 9, mean age = 41), and men without a CSA history nor PTSD (n = 13, mean age = 36) participated in the study at a local hospital. METHODS: Participants completed a letter n-back task and an emotional picture n-back task during fMRI to measure working memory and the influence of emotion on working memory. They also completed self-report measures to assess mental health and childhood abuse histories. RESULTS: In the letter n-back task, men with CSA + PTSD had less activation in the cerebellum and left fusiform gyrus compared to CSA-PTSD men. During the working memory task with negative emotional pictures the control group had greater frontal activation, while the CSA-PTSD group had greater limbic activation. Analyses were performed with independent-samples t-tests. CONCLUSIONS: This study provides preliminary empirical evidence of the impact CSA can have on men regarding working memory when negative stimuli are involved. It highlights that CSA, even without a diagnosis of PTSD, can have a significant neurophysiological impact. It also provides clinicians with information to support well-being and help with potential day to day challenges.

Meta-Analysis on Interventions for Children Exposed to Intimate Partner Violence.

Several reviews have been conducted on children's outcomes following exposure to intimate partner violence (IPV), but there remain inconsistent findings. We conducted a meta-analysis on child emotional and behavioral outcomes of IPV exposure interventions, based on published reviews that included a child component. We also explored relative effect sizes by examining moderators of the effect sizes across studies. This meta-analysis included 21 evaluation studies across 12 published reviews, which were located using a multiple database systematic search of English publications between 2000 and 2019. Studies were required to evaluate IPV interventions that included children, to gather quantitative pre- and post-intervention data on child outcomes, to use standardized instruments, and to present data in a format that could be used in a meta-analysis. Results indicated an overall pre- to post-intervention medium effect size (d = 0.49), with effect sizes ranging from small to large depending on the specific outcome. Improvements at follow-up were maintained for internalizing behaviors but decreased for trauma-related symptoms and social, externalizing, and total behaviors. However, externalizing and total behavior outcomes still had significant effect sizes in the small-to-medium range (d = 0.36 and 0.44). There were greater intervention effects when treatment was not exclusively trauma-specific. It appears that IPV exposure interventions are generally effective for improving children's emotional and behavioral well-being, although interventions would benefit from greater tailoring to children's specific needs. Interventions may also benefit from incorporating various content areas (both trauma-specific and non-trauma-specific) and from greater focus on ensuring the maintenance of treatment gains.

How Do Knowledge and Attitudes About Children's Rights Influence Spanking Attitudes?

Children's rights are about treating children with equality, respect, and dignity. Attitudes concerning children's rights have been linked to support for nurturance and self-determination. However, there is little research on how dimensions of children's rights are associated with other parenting constructs, such as attitudes toward physical punishment. This study examined the relationship between knowledge of and attitudes toward children's rights and attitudes toward spanking in a Canadian sample of 329 undergraduate students who completed an online study. Hierarchical multiple regression analyses indicated a significant negative association in that more favorable attitudes toward children's rights predicted less favorable attitudes toward spanking. There also was a significant moderating effect of child rights knowledge on this relationship, such that greater knowledge enhanced the effects of attitudes toward children's rights on spanking attitudes. These results raise awareness of the combined role of both knowledge of and attitudes toward children's rights in influencing spanking attitudes. The results also suggest that one pathway decreasing favorable attitudes toward spanking may be to increase the general public's knowledge of children's rights.

Using Research within Child Welfare: Reactions to a Training Initiative.

PURPOSE: Efforts to incorporate evidence-informed practice within child welfare have been increasingly adopted to promote positive outcomes for youth. We established partnerships with three child welfare agencies to develop, implement, and evaluate a training curriculum delivered to senior managers and supervisors. The training focused on the use of data from an Ontario performance measure system. Despite its mandatory use, challenges remain in the applied use of the data to organizational governance and planning. METHOD: This pilot study examined senior managers' and supervisors' perspectives of the training using a mixed-methods design consisting of a training feedback questionnaire and post-training focus groups. RESULTS: Results indicated that participants responded positively to the training content, delivery, and facilitators. Participants identified that it was helpful to learn about applied data and evidence-informed practice. CONCLUSION: These findings highlight the importance of ongoing training initiatives within child welfare to promote an organizational culture supportive of evidence-informed practice.

Development of evidence-based guidelines: local working conditions hamper adaptation and use of recommendation.

INTRODUCTION: Clinical practice guidelines need rigorous and transparent methods for summarizing the evidence, rate its certainty and moving from evidence to recommendations. We describe an intervention to support local efforts to provide optimal and safer care bridging the gap between researchers and local busy clinicians. METHODS: A group of methodologists provided a wide range of research services to the medical community of a local non-teaching general hospital in Italy. Methodological support encompassed synthesis of evidence, rating of uncertainty and moving from evidence to recommendations. Local professionals were asked to judge GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology and its impact on patients' safety, professional liability, and guideline reliability. The research team then reflected on the barriers of implementing GRADE in local settings. RESULTS: Seven clinical recommendations about frequent complex medical conditions were produced. Few local clinicians completed the project. All clinicians found the GRADE methodology a guarantee for defending excellent standards of care. However, we identified a diffuse sense of inability to improve clinical behaviours as negative effects of general poor working conditions, in particular the strained health care workforce. DISCUSSION: Current financial constraints may be impeding the ability of clinicians in improving their clinical practice through adaptation and use of evidence. A successful integration of evidence-based guidelines cannot be separated from an activate promotion by the institutional management.

What Quality and Safety of Care for Patients Admitted to Clinically Inappropriate Wards: a Systematic Review.

BACKGROUND: In countries with public health system, hospital bed reductions and increasing social and medical frailty have led to the phenomenon of "outliers" or "outlying hospital in-patients." They are often medical patients who, because of unavailability of beds in their clinically appropriate ward, are admitted wherever unoccupied beds are. The present work is aimed to systematically review literature about quality and safety of care for patients admitted to clinically inappropriate wards. METHODS: We performed a systematic review of studies investigating outliers, published in peer-reviewed journals with no time restrictions. Search and screening were conducted by two independent researchers (MLR and ER). Studies were considered potentially eligible for this systematic review if aimed to assess the quality and/or the safety of care for patients admitted to clinically inappropriate units. Our search was supplemented by a hand search of references of included studies. Given the heterogeneity of studies, results were analyzed thematically. We used PRISMA guidelines to report our findings. RESULTS: We collected 17 eligible papers and grouped them into six thematic categories. Despite their methodological limits, the included studies show increased trends in mortality and readmissions among outliers. Quality of care and patient safety are compromised as patients and health professionals declare and risk analysis displays. Reported solutions are often multicomponent, stress early discharge but have not been investigated in the control group. CONCLUSIONS: Published literature cannot definitely conclude on the quality and safety of care for patients admitted to clinically inappropriate wards. As they may represent a serious threat for quality and safety, and moreover often neglected and under valued, well-designed and powered prospective studies are urgently needed.

Men with childhood sexual abuse histories: Disclosure experiences and links with mental health.

BACKGROUND: There is limited research on the disclosure experiences of men who have experienced childhood sexual abuse and on how such experiences might impact mental health outcomes. OBJECTIVE: The current study described men's disclosure experiences and examined the role of disclosure characteristics on mental well-being (internalizing and externalizing behaviors, substance use, resilience). PARTICIPANTS AND SETTING: Men (N = 253) from across Canada and the U.S. were recruited through websites for males with sexual abuse histories. Men aged 18-59 years anonymously completed an online study on their sexual abuse, disclosure experiences, and mental health outcomes. RESULTS: Findings indicated that 77.9% of men disclosed their sexual abuse, although they waited an average of 15.4 years before sharing their experience. Once disclosed, 64.4% of the men reported a positive response (e.g., support), while 35.6% reported a negative response (e.g., blame). Regression analyses indicated that a greater delay in disclosure predicted greater externalizing behaviors (B = .49, p < .05), although this was a small effect (Cohen's f2 = 0.02). Additional disclosure variables were associated with components of externalizing (aggressive and rule-breaking behaviors) and internalizing (somatic complaints) behaviors. CONCLUSIONS: These results require replication in future studies. However, they do suggest that efforts need to be undertaken to address the barriers that hinder men from disclosing their sexual abuse and to ensure that men are supported once they disclose.

Childhood Sexual Abuse Profiles and Psychological Functioning in Adult Males.

This study used a person-centered approach to generate profiles of males' sexual abuse characteristics and then link profiles to other types of childhood maltreatment and adversity, and adult outcomes. Data were drawn from 215 North American males (86% Caucasian) aged 17-61 years recruited from websites offering support for sexual abuse. Latent profile analysis identified three profiles, ranging from 1-2 instances of fondling by an unfamiliar extrafamilial perpetrator to chronic, penetrative abuse by individuals within and outside the family. Profiles were labeled Severe (26%), More Severe (33%), and Most Severe (41%). Chi-squares and analysis of variance showed that men in the Most Severe profile were more likely to experience childhood emotional and physical abuse, and a greater number of non-victimization adversities, than men in the other two profiles. After controlling for multiple victimization and adversity, men in the More Severe and Most Severe profiles reported significantly greater internalizing problems than men in the Severe profile, and men in the Most Severe profile reported significantly more trauma symptoms than men in the Severe profile. While these results require replication, they suggest that treatment should be tailored to the individual needs of male survivors.

Safeguarding child rights and enhancing caregiver responsibilities among Canadian parents of youth who sexually offend.

Research on youth sexual offending has focused primarily on its prevalence. However, recent efforts have begun to consider the collateral consequences for the relatives of offending youth, although little has been done in this regard toward exploring caregiver accountability. This study presents qualitative data on parents' sense of responsibility in situations where their child engaged in sexual offending behaviour against another child. We analyzed interview data among 16 parents from 10 families in Canada using thematic coding procedures. Findings illustrated the range of responsible actions that caregivers of sexual offending youth undertook with regard to preventing recidivism and accessing appropriate services for all the abuse-affected children. Caregivers reported on the enormous complexities they encountered as they attempted to simultaneously attend to the best interests of both the victim and offending youth. A particularly significant theme was that, despite the overwhelming challenges caregivers faced in dealing with the needs of their offending child, they were also highly attentive to the well-being of the victims. Our findings point to the importance of comprehensive and non-biased support services for both children and caregivers in order to fully uphold the rights of all affected individuals, and to better meet the needs as well as best interests of sexual abuse-affected children.

Trauma-symptom profiles of adolescents in child welfare.

In the province of Ontario (Canada), over 28,900 adolescents are investigated by child welfare agencies each year because of suspected maltreatment. Exposure to childhood maltreatment represents a major threat to the psychological well-being of young people, particularly in terms of trauma-related stress. The present study investigated trauma symptom profiles among 479 adolescents (13-17 years) involved with the Canadian child welfare system between 2003 and 2010. Latent profile analysis identified three profiles using self-report data from the Trauma Symptom Checklist for Children. Most adolescents (59%, n=281) were classified into the profile depicting minimal trauma-related symptoms, 30% (n=144) were characterized by moderate trauma-related symptoms, and 11% (n=54) were in the profile reflecting severe trauma-related symptoms. Several variables predicted profile membership. Greater severity of sexual abuse and female sex were associated with a greater likelihood of belonging to the severe trauma symptom profile than both the moderate and the minimal trauma symptom profiles. In addition, having society ward status (compared to crown ward) was related to an increased likelihood of belonging to both the severe and moderate symptom profiles relative to the minimal symptom profile. This study provides some insight into the typologies of trauma experienced among child-welfare-involved adolescents and the set of factors which relate to the specific profiles. Findings are important for informing psychological assessment practices, as well as tailored interventions, for adolescents in the child welfare system.

How do parents label their physical disciplinary practices? A focus on the definition of corporal punishment.

The lack of consensus about the definition of corporal punishment (CP) contributes to the varying research findings and fuels the debate surrounding its use. Related to the problem of definitional variability is also the possibility that some parents may not be aware that their physical disciplinary strategies (PDS) are forms of CP. As a first step to move beyond the debate and to tailor educational efforts to change cultural norms and parents' behaviors, the objective of the current study was to clarify what parents self-label as CP. Using a sample of 338 Canadian parents, the study assessed the relationship between endorsement of CP and self-reports of specific PDS ranging in level of severity. Predictors (i.e., cultural norms, attitudes toward and childhood experiences of CP) of this relationship were investigated. Results revealed that general questions on CP may best reflect parental use of milder forms of PDS, such as spanking (Φ=0.62; r=-0.65) and slapping on the hand, arm, or leg (r=-0.47). Results also suggested that some parents (19.8%) do not endorse CP but use mild PDS. To move beyond the debate and to reach parents at risk of underreporting their use of CP, educational messages need to be tailored to specific and mild forms of PDS rather than to broad concepts such as CP. Moreover, factors such as attitudes toward corporal punishment (p ˂0.001) can help identify those parents who use PDS but who do not endorse CP.

Permanency and Safety Among Children in Foster Family and Kinship Care: A Scoping Review.

Over the past 25 years, kinship care placements have risen dramatically, such that when a child enters into care, child welfare agencies must first attempt to identify safe living arrangements with relatives or individuals known to the child before searching for alternatives. Despite the growing emphasis on kinship care, little is known about its impact on child outcomes in comparison to other placement types (e.g., foster family). Therefore, the aim of this scoping review was to evaluate quantitative research on children in out-of-home care from 2007 to 2014 with regard to the following outcomes: (1) permanency (i.e., reunification, reentry, placement stability, and adoption/guardianship) and (2) safety (e.g., additional reports to child welfare). Based on these objectives, the review identified 54 studies that examined permanency and safety among children in two major placement types, namely foster family and kinship care. Across studies, children in kinship care experienced greater permanency in terms of a lower rate of reentry, greater placement stability, and more guardianship placements in comparison to children living with foster families. Children in kinship care, however, had lower rates of adoption and reunification. The findings also indicated that differences in these variables diminish over time. Findings for safety outcomes were mixed. Study methodological limitations and recommendations for future research are considered.