Buenas prácticas, tensiones y desafíos ético-deontológicos en la evaluación psicológica forense del maltrato y abuso sexual infantil / Good practices, tensions and ethical-deontological challenges in the forensic psychological assessment of child mistreatment and sexual abuse / Bones pràctiques, tensions I desafiaments ètico-deontològics en l'avaluació psicològica forense del maltractament I abús sexual infantil

La evaluación psicológica forense del maltrato y del abuso sexual ha sido abordada prioritariamente desde una perspectiva técnico-metodológica. La consideración de los aspectos ético-deontológicos implicados ha resultado más incipiente y comienzan gradualmente a integrarse como una dimensión relevante de la práctica profesional. El presente artículo explora las principales tensiones y desafíos para los psicólogos que realizan evaluaciones forenses en esta materia. Se revisan cómo los principios rectores de la bioética se adaptan a la realidad de las evaluaciones forenses que permiten orientar el desarrollo de buenas prácticas en el área

The forensic psychological evaluation of mistreatment and sexual abuse has been addressed primarily from a technical-methodological perspective. Considerations of the ethical-deontological aspects involved has been more incipient, and gradually beginning to be integrated as a relevant dimension of professional practice. This article explores the main tensions and challenges for psychologists who perform forensic evaluations in this area. We review how the guiding principles of bioethics adapt to the reality of forensic evaluations that allow to guide the development of good practices in the área

L'avaluació psicològica forense del maltractament I abús sexual ha estat abordada prioritàriament des d'una perspectiva tècnico-metodològica. La consideració dels aspectes ètico-deontològics implicats ha resultat més incipient I comencen gradualment a integrar-se com una dimensió rellevant de la pràctica professional. El present article explora les principals tensions I desafiaments per als psicòlegs que realitzen avaluacions forenses en aquesta matèria. Es revisen com els principis que regeixen la bioètica s'adapten a la realitat de les avaluacions forenses que permeten orientar el desenvolupament de bones pràctiques al sector

Cuerpos profanados, mentes quebrantadas. Abuso sexual infantil / Profaned bodies, broken minds. Child sexual abuse / Cossos profanats, ments trencades. Abús sexual infantil

El presente trabajo intenta abordar las complejidades del abuso sexual infantil, desde la mente del abusado y del abusador. A través de algunas viñetas clínicas, se mostrarán distintos tipos de abuso en niños y adolescentes, diferenciando estados mentales perversos, polimorfos y psicóticos de los abusadores, así como su intencionalidad. También en la clínica se analizarán las diferentes reacciones de los niños y adolescentes abusados y la postura ética del analista frente a estos hechos

This paper attempts to address the complexities of child sexual abuse from the mind of the abused and the abuser. Through some clinical vignettes, different types of abuse in children and adolescents will be shown, differentiating abusers 'perverse, polymorphic and psychotic mental states, as well as their intentionality. The clinic will also analyse the different reactions of abused children and adolescents and the analyst's ethical stance regarding these facts

El present treball intenta abordar les complexitats de l'abús sexual infantil, des de la ment de l'abusat I de l'abusador. A través d'algunes vinyetes clíniques, es mostraran diferents tipus d'abús en nens I adolescents, així com la seva intencionalitat. També en la clínica s'analitzaran les diferents reaccions dels nens I adolescents abusats I la postura ètica de l'analista davant aquests fets

A Narrative on The Witch-Hunt Narrative: The Moral Dimensions.

Ross Cheit's The Witch-Hunt Narrative raises a number of complex moral issues. Cheit's principal purpose is to challenge the belief that our society has overreacted to claims about the sexual abuse of children. Both directly and indirectly, Cheit's in-depth analysis broaches moral concerns pertaining to the integrity of child abuse allegations, investigations, civil litigation, and criminal prosecution, with an emphasis on the mixed motives of the parties involved in key cases. This article provides an overview of ethical questions pertaining to gathering information from very vulnerable individuals, informed consent, institutional review, protection of research participants, the use of deception and coercion, confidentiality and privacy, reporting research results, and conflicts of interest. In addition, the author discusses the phenomenon of whistle-blowing as it pertains to professionals' ethical judgments about disclosure of wrongdoing and misconduct. The author outlines key ethics-related concepts, applies relevant moral theory, and explores the implications of the moral issues raised by The Witch-Hunt Narrative for child sexual abuse victims, perpetrators, child welfare and law enforcement professionals, scholars and researchers, and the public at large.

[Child sexual abuse: clinical perspectives and ethico-legal dilemmas]. / Abuso sexual infantil: perspectiva clínica y dilemas ético-legales.

OBJECTIVES: In the review of the current literature, the main causing factors of the related conditions with child sexual abuse are the ethical dilemmas and legal implications. METHODS: A review was conducted on the classic literature on this topic. In this articlesome difficult paradigmatic cases are presented in which the hypothetical dilemmas were solved. RESULTS: The main characteristics of child sexual abuse enable us to have a better argument to address these situations. CONCLUSIONS: Taking into account the literature reviewed and predictable courses of action, it is concluded that it is important to take into account each individual each case and its circumstances, and that prudence and clinical objectivity, as well as knowledge of the law, become essential requirements for proper action.

"I never expected that it would happen, coming to ask me such questions":Ethical aspects of asking children about violence in resource poor settings.

BACKGROUND: International epidemiological research into violence against children is increasing in scope and frequency, but little has been written about practical management of the ethical aspects of conducting such research in low and middle-income countries. In this paper, we describe our study procedures and reflect on our experiences conducting a survey of more than 3,700 primary school children in Uganda as part of the Good Schools Study, a cluster randomised controlled trial of a school-based violence prevention intervention. Children were questioned extensively about their experiences of physical, sexual, and emotional violence from a range of different perpetrators. We describe our sensitisation and consent procedures, developed based on our previous research experience and requirements for our study setting. To respond to disclosures of abuse that occurred during our survey, we describe a referral algorithm developed in conjunction with local services. We then describe our experience of actually implementing these procedures in our 2012 survey, based on reflections of the research team. Drawing on 40 qualitative interviews, we describe children's experiences of participating in the survey and of being referred to local child protection services. RESULTS: Although we were able to implement much of our protocol in a straightforward manner, we also encountered major challenges in relation to the response of local services to children's disclosures of violence. The research team had to intervene to ensure that children were provided with appropriate support and that our ethical obligations were met. CONCLUSIONS: In resource poor settings, finding local services that can provide appropriate support for children may be challenging, and researchers need to have concrete plans and back-up plans in place to ensure that obligations can be met. The merits of mandatory reporting of children's disclosures to local services need to be considered on a case by case basis-in some places this has the potential to do harm. Research teams also must agree on what level of ancillary care will be provided, and budget accordingly. Further practical examples of how to address the challenges encountered in this work are needed, in order to build a consensus on best practices. TRIAL REGISTRATION: NCT01678846 (clinicaltrials.gov), August 24, 2012.

Depoimento especial: para além do embatee pela proteção das crianças e adolescentes vítimas de violência sexual / Special testimony: beyond legal conflicts and in favor of the protection of children and adolescents victims of sexual violence / Tomada de testimonio especial: para allá de la oposición y por la protección de niños y adolescentes víctimas de violencia sexual

A nova metodologia de inquirição de crianças e adolescentes vítimas de abuso sexual pelo Poder Judiciário denominada Depoimento Especial tem sido discutida por profissionais de diferentes áreas do conhecimento. Dessas discussões, resultaram opiniões divergentes sobre o assunto. Esse artigo visa apresentar historicamente a metodologia do Depoimento Especial, primeiramente denominado Depoimento Sem Dano, e discutir as necessidades de a Justiça dialogar com outros saberes para um melhor direcionamento da realização deste ato processual - a ouvida da criança. Conclui-se, a partir da revisão de literatura e da interlocução entre Psicologia e Direito, que as discordâncias e debates legais não têm contribuído para a proteção das vítimas. O Poder Judiciário e outras áreas do conhecimento precisam fortalecer suas habilidades para trabalhar em conjunto numa interlocução respeitosa e equânime troca de conhecimentos. A realização da nova metodologia é possível e necessária, entretanto, mudanças podem trazer benefícios e maior proteção a crianças e adolescentes brasileiros.

The Judiciary Inquiry method of testimony for children and adolescents who suffered sexual abuse, called special testimony, has been discussed by professionals and there are divergent opinions about it. This article aims to present historically the Special Inquiry method that has been used in Brazil, firstly named Testimony without Damage, and discuss the needs of the area for a better direction of this activity. The conclusions from the literature review and interlocution between Psychology and Law show that these legal and technical disagreements seem not to be working in children's favor. The area needs to reinforce the abilities to work together in a respectful dialogue with an equitable knowledge exchange. The practice of the special testimony is possible and necessary, however some changes can bring benefits and greater protection for Brazilian children and adolescents.

La nueva tecnología de escucha de niños y adolescentes víctimas de abuso sexual por el Poder Judicial denominada Tomada de Testimonio Especial es tema de discusión de profesionales de distintas áreas del conocimiento. De esas discusiones resultaron opiniones divergentes acerca del asunto. Este artículo busca presentar históricamente la metodología de la Tomada de Testimonio Especial, primeramente denominada Testimonio Sin Daño, y discutir las necesidades de que la Justicia dialogue con otros saberes para una mejor dirección en la realización de este acto procesual - la escucha de niños. Se concluye, partiendo de la revisión de literatura y de la interlocución entre Psicología y Derecho, que las discordancias y debates legales no contribuyen para la protección de las víctimas. El Poder Judicial y otras áreas del conocimiento necesitan fortalecer sus habilidades para trabajar en conjunto en una interlocución respetuosa y ecuánime cambio de conocimientos. La realización de la nueva tecnología es posible y necesaria, sin embargo, cambios pueden traer beneficios y mayor protección a los niños y adolescentes brasileños.

Faith to move mountains: religious coping, spirituality, and interpersonal trauma recovery.

Interpersonal trauma is pervasive globally and may result in long-term consequences physically, cognitively, behaviorally, socially, and spiritually (Bryant-Davis, 2005b). One of the protective factors that have emerged in the literature is religious coping. Religious coping, spirituality, and faith-based approaches to trauma recovery include endorsement of beliefs, engagement in behaviors, and access to support from faith communities. Compared with negative religious coping, spirituality and positive religious coping have been associated with decreased psychological distress, a finding established with survivors of child abuse, sexual violence, intimate partner violence, community violence, and war. This article focuses on spiritual and religious coping among survivors of child abuse, sexual violence, and war; however, research demonstrates increased use of positive religious coping among some survivors with higher rates of posttraumatic stress disorder. Much of the scholarship in this area includes qualitative studies with populations who face increased vulnerability to interpersonal trauma. Research in this area covers the life span from childhood to later adulthood and encompasses both domestic and international studies. The implications of research findings are explored, and future research needs are described. This line of research supports the American Psychological Association (2010) ethical standards that note the recognition of spiritual and religious faith traditions as important aspects of the provision of ethical treatment. Researchers, clinicians, and advocates for trauma survivors are encouraged to attend to the faith traditions and beliefs of persons confronting the potential devastation of traumatic events.

Psicologia jurídica em situações de abuso sexual: possibilidades e desafios¹ / Forensic psychology in sexual abuse situations: possibilities and challenges

Este trabalho investigou as percepções de psicólogas judiciárias sobre seu papel em situações de abuso sexual contra crianças e adolescentes. Foram entrevistadas cinco profissionais de comarcas de diferentes municípios do Estado do Rio Grande do Sul com experiência na área. O conteúdo das entrevistas foi analisado, utilizando o software webQDA, com quatro categorias geradas a posteriori: (1) potencialidades da Psicologia; (2) dificuldades; (3) requisitos para a tarefa; e (4) tomada de decisão. Os dados demonstram que o trabalho das psicólogas judiciárias faz a intermediação entre as necessidades do judiciário e da população envolvida em situações de violência, contribuindo tanto na comprovação do fato como na proteção dos envolvidos. Para isso, as profissionais utilizam habilidades pessoais, diferentes fontes de informação, recursos teóricos e técnicos. Conclui-se destacando as possibilidades do fazer psicológico no contexto da Justiça e a importância e a necessidade de maior integração entre as áreas da Psicologia e do Direito...

This study investigated the perceptions of forensic psychologists about their role in sexual abuse situations against children and adolescents. Five professionals with experience in this area working in different cities of Rio Grande do Sul were interviewed. The content of the interviews was analyzed with software webQDA, generating four categories: (1) the potential of Psychology; (2) difficulties; (3) requirements for the task; and (4) decision making. Data showed that the work of the psychologists reconciles the needs of the justice system with those of the population involved in violence situations, contributing to prove the fact and to protect those involved. Professionals use personal abilities, different sources of information, theoretical and technical resources for accomplishing this task. Conclusions highlight the possibilities of the psychological practice in the Justice Sistem and also the relevance and necessity of integrating Psychology and Law areas...

Psicologia jurídica em situações de abuso sexual: possibilidades e desafios¹ / Forensic psychology in sexual abuse situations: possibilities and challenges

Este trabalho investigou as percepções de psicólogas judiciárias sobre seu papel em situações de abuso sexual contra crianças e adolescentes. Foram entrevistadas cinco profissionais de comarcas de diferentes municípios do Estado do Rio Grande do Sul com experiência na área. O conteúdo das entrevistas foi analisado, utilizando o software webQDA, com quatro categorias geradas a posteriori: (1) potencialidades da Psicologia; (2) dificuldades; (3) requisitos para a tarefa; e (4) tomada de decisão. Os dados demonstram que o trabalho das psicólogas judiciárias faz a intermediação entre as necessidades do judiciário e da população envolvida em situações de violência, contribuindo tanto na comprovação do fato como na proteção dos envolvidos. Para isso, as profissionais utilizam habilidades pessoais, diferentes fontes de informação, recursos teóricos e técnicos. Conclui-se destacando as possibilidades do fazer psicológico no contexto da Justiça e a importância e a necessidade de maior integração entre as áreas da Psicologia e do Direito.(AU)

This study investigated the perceptions of forensic psychologists about their role in sexual abuse situations against children and adolescents. Five professionals with experience in this area working in different cities of Rio Grande do Sul were interviewed. The content of the interviews was analyzed with software webQDA, generating four categories: (1) the potential of Psychology; (2) difficulties; (3) requirements for the task; and (4) decision making. Data showed that the work of the psychologists reconciles the needs of the justice system with those of the population involved in violence situations, contributing to prove the fact and to protect those involved. Professionals use personal abilities, different sources of information, theoretical and technical resources for accomplishing this task. Conclusions highlight the possibilities of the psychological practice in the Justice Sistem and also the relevance and necessity of integrating Psychology and Law areas.(AU)

Nurses' perspectives on the care of adults with mental health problems and histories of childhood sexual abuse.

Despite growing awareness and evidence linking childhood sexual abuse (CSA) to numerous ongoing health problems in adulthood, the integration of this knowledge into nursing practice remains inconsistent. This article reports the results of a study that explored nurses' perspectives on, and experiences with, providing care for adults with mental health problems who may also have histories of CSA. Nurses' views underscore the challenges and complexities involved when providing care for this population. The themes of nurses' knowledge and comfort levels, ethical practice, patient care considerations, and system issues are used to discuss nurses' understandings, perspectives, and experiences.

Health care and female survivors of childhood sexual abuse: health professionals' perspectives.

The present study explored health professionals' experiences with adult survivors of child sexual abuse in New Zealand. Face-to-face, semistructured interviews of up to an hour took place with 13 health professionals. The participants were asked about training, screening practices, their response to disclosures, and advice to other health professionals. A model-transition to ethical practice-emerged from the data, where delivering more sensitive health care to child sexual abuse survivors sits on a continuum from lack of awareness of child sexual abuse to delivery of care where all patients are comfortable. We recommend making sensitive care for all as the standard care of practice and providing training for health professionals on how to deal with disclosures.

Tratamiento psicológico de mujeres adultas víctimas de abuso sexual en la infancia: resultados a largo plazo / Psychological treatment of adult female survivors of childhood sexual abuse: long term results

El abuso sexual (ASI) constituye la victimización más frecuente en la infancia. Los efectos del ASI en la vida adulta pueden afectar al funcionamiento, físico, psicológico y social y generar alteraciones psicopatológicas. El objetivo de este estudio fue evaluar un programa individual cognitivo-conductual, de 12 sesiones, en el tratamiento de mujeres adultas víctimas del ASI, llevado a cabo durante 20 años en un marco comunitario. La muestra constó finalmente de 121 sujetos que participaron voluntariamente en el estudio. Se utilizó un diseño de medidas repetidas con seguimientos de 1, 3, 6 y 12 meses. La tasa de éxitos en el tratamiento del trastorno de estrés postraumático fue del 90.7% en las víctimas que completaron el tratamiento. A pesar de la pérdida de pacientes en los seguimientos (25.58%), los resultados se mantuvieron en las pacientes evaluadas en los cuatro periodos establecidos (un 74.42% al cabo de 12 meses), con una alta reducción de las recaídas. Sin embargo, hubo un nivel más bien alto de rechazos y de abandonos. Una conclusión es que hay que desarrollar estrategias motivacionales para mantener a las víctimas en el tratamiento. Se comentan las implicaciones de este estudio para la práctica clínica y para la investigación (AU)

Child sexual abuse (CSA) is one the most common forms of child victimization. The effects of CSA can extend into adulthood, impacting on physical, psychological, and social functioning and contributing to adult psychopathology. The aim of this paper was to evaluate an individual 12 sessions cognitive-behavioral programme in the treatment of female adult survivors of CSA after implementing it for twenty years in a community setting. The sample consisted of 121 subjects who voluntarily participated in the study. A design with repeated measures (pre-treatment, post-treatment and 1-, 3-, 6- and 12-month follow-up) was used. The success rate regarding posttraumatic stress disorder was of 90.7% in the treatment completers. In spite of the lost patients in the follow-ups (25.58%), the results were maintained in the contacted patients at follow-up (74.42% in the 12-month-follow-up), with a high impact on reducing recidivism. However, the rate of refusals and drop-outs of the treatment was rather high. There-fore it is necessary to develop strategies to improve motivation for treatment. Implications of this study for clinical practice and future research in this field are commented upon (AU)

Enfoque multidisciplinar de la exploración del abuso sexual infantil / Multidisciplinary approach in the exploration of child sexual abuse

La victimización sexual en la infancia es un problema de considerable magnitud, para el que los profesionales no siempre se encuentran adecuadamente preparados. Una correcta evaluación de estos casos implica considerar indicadores físicos y psicológicos, relativos al menor víctima, así como los factores de riesgo social, vinculados al entorno familiar. Los hallazgos físicos son escasos, si bien constituyen una de las pruebas más objetivas de la experiencia de abuso sexual. Los indicadores conductuales que incluyen la conducta sexualizada y la sintomatología postraumática, así como los índices de veracidad del relato del menor son los principales aspectos psicológicos a evaluar. La existencia de abusos previos en las figuras parentales del menor víctima es un factor de riesgo social que debe considerarse. La exploración del abuso sexual infantil supone un reto para cualquier profesional, que debe afrontarse desde un equipo multidisciplinar con la adecuada formación y experiencia(AU)

Sexual victimization in childhood is a major social problem for which professionals are not always adequately prepared. Evaluation of these cases involves considering physical and psychological indicators related to the child victim as well as social risk factors linked to the family environment. Despite physical findings being scarce, they constitute one of the most objective evidence of sexual abuse experience. Behavioral indicators −including sexualized behavior and posttraumatic symptomatology− are the main psychological aspects to undergo evaluation. Assessment of the veracity of sexual abuse allegations is also important. The presence of previous abuse in the parental figures of the child victim is a social risk factor to be considered. The exploration of child sexual abuse represents a challenge for any professional that needs to be addressed by a multidisciplinary team with appropriate training and experience(AU)

Signos cutáneos del maltrato infantil / Skin Signs in Child Abuse

El maltrato infantil es mucho más frecuente de lo que generalmente se reconoce. Hasta el 90% de las víctimas que sufren maltrato físico presentan hallazgos cutáneos. El dermatólogo es el profesional más cualificado para identificar los signos cutáneos del maltrato y diferenciarlos de aquellas condiciones dermatológicas que puedan simularlo. En este artículo se revisan las manifestaciones cutáneas del maltrato infantil, indicando pistas que pueden ayudar al dermatólogo a discernir entre las heridas causadas por un maltrato y aquellas producidas accidentalmente, así como las condiciones dermatológicas que puedan imitarlo (AU)

Child abuse is far more prevalent today than is generally recognized. Up to 90% of victims suffer physical abuse that can be observed in signs on the skin. Dermatologists are particularly qualified to identify these signs and distinguish them from other conditions that can mimic abuse. This review covers the signs of child abuse that can be observed on the skin. We discuss clues that can help differentiate between lesions caused by abuse and those that are accidental, and we describe the skin conditions that mimic physical abus (AU)

A call for field-relevant research about child forensic interviewing for child protection.

This article reviews some sensitivity versus specificity imbalances in forensic investigations of child sexual abuse. It then proposes the development or further testing of additional approaches for those children who do not respond to the current, single-interview National Institute of Child Health and Human Development (NICHD) protocol. Although there are other interview protocols based on similar principles, the NICHD protocol has the strongest evidence base in both field and laboratory studies to elicit detailed and accurate information from children. Adaptations of the NICHD protocol or additional approaches need to be developed and tested for nondisclosing, partially disclosing, or recanting children, very young children, children with developmental disabilities, and children whose sexual abuse allegations are evaluated in the context of custody or visitation disputes.