1. California Common Core Training Version 1.25
CHILD MALTREATMENT IDENTIFICATION, PART II: Sexual Abuse and Exploitation
California Common Core Training
Version 1.25

2. Learning Objectives/Overview
Present the historical background, legal definitions and dynamics of child sexual abuse;
Discuss characteristics of perpetrator, victim, and non-offending caretaker;
Identify physical, behavioral, and emotional indicators of child sexual abuse;
Examine the dynamics involved in sexual abuse and sexual exploitation;
Practice identifying child sexual abuse when allegations occur.

3. History: Current U. S. “Discovery” Cycle
Some publications for specific disciplines began to appear in the early 1980’s.
“Stranger-Danger” was believed to be the most common form of child sexual molestation.
During this same time period, the McMartin/Manhattan Beach, Country Walk, and Jordon, MN multiple victim cases involving pre-schoolers were publicized.

4. History: System Responses
Mandatory Reporting
Specialized Investigative Units Formed
Government Sponsored Trainings Developed
Joint Investigations Between CPS & LE Begun
Increased Criminalization of Incest
Child Advocacy Center Concept Begins
State and Federal Laws Enhanced or Developed
Research on Child Sexual Abuse Begins
Child Interviewing Protocols Developed

5. And Now For You…
Possible personal difficulties in working cases with sexual aspects:
Emotional reactions are expected and normal
Matters dealing with sexualized behaviors are very personal and value laden
Sexual abuse victimization history
Parenthood
Personal feelings concerning sexuality, sexually motivated behaviors, and children and sexuality

6. Questions For You…
Where and under what conditions you were taught or learned about sex, sexuality, and what is appropriate or inappropriate sexual behaviors?
Who informed you?
What were your emotions and what caused them?
Girls were told by? Boys were told by?
Cultural Differences?

7. Question for you. . .
What are some ways that your own views of sexuality may impact your handling of situations involving the sexual abuse of children?

8. Exercise: Body Part Identification
All terms or phrases are considered
Clinical/ “proper”
Slang/ Euphemisms
Cultural
Write on post-its and place on appropriate body part
Most post-its up wins for the team

9. General Definition Components
Sexual contact that is accomplished by threats or threat of force, regardless of the ages of participants;
All sexual contact between an adult and a child regardless of whether there is deception or the child understands the sexual nature of the activity;
Sexual contact between a teenager and a younger child can also be abusive if there is a significant disparity in age, development, or size, rendering the child victim incapable of giving informed consent. (Ryan, 1991)
See California Penal Code (a,b,c,)

10. Continuum of Behaviors
Non-contact sexual acts such as exposure, voyeurism, showing or producing pornography, masturbation or other sexual acts in front of the child;
Touching of the sexual or erogenous zones or touching designed for the sexual gratification of the perpetrator or for the furtherance of sexual activity;
Penetration of vagina, anus, mouth

11. Legal Definitions for Sexual Assault and Sexual Exploitation
California Welfare & Institutions Code (WIC) Section 300(d)
California Penal Code (PC) Sections

12. Informed Consent The dimensions of informed consent:
1. Know what is being requested
2. Have a thorough understanding of the consequences of the behavior
3. Have an equal power base in the relationship
4. Be able to say no without repercussions
Abel, G.G., Becker, J.V., & Cunningham-Rathner. (1984). Complications, consent, and cognitions in sex
between children and adults. International Journal of Law and Psychiatry, 7,

13. Prevalence 9.7% of maltreatment reports involve sexual abuse (2004)
% of American females who are sexually abused or exploited in some manner before 18:
1 in 3-4
% of American males who are sexually abused or exploited in some manner before 18:
1 in 7-10 (underreporting a major issue)
90-95% of sexual abuse is perpetrated by someone the child knows. *
Child abuse reporting systems and clinical programs tend to over represent intrafamilial cases. Based on general population surveys, abuse by parent figures constitutes between 6 and 16% of all cases, and abuse by any relative comprises more than 1/3 of cases.

14. Prevalence The challenge of the numbers…
All are estimates and have limitations:
Different studies use different definitions.
Child abuse reporting and clinical programs tend to over-represent intrafamilial cases.
Cases reported by official agencies meet a particular standard, many cases never get reported so these data sources underestimate the number of victims.
Numbers are reported for different time periods.

15. Key Questions: Child Welfare
Does the allegation involve intra-familial abuse?
Is the child safe?
Did abuse occur, per WIC Section 300?
* Also refer to Trainee Content re: When Consensual Sexual Intercourse is Deemed Child Abuse in California
Is the caregiver able/willing to protect the child?
Is there a viable safety plan to allow the child to stay in the home?

16. Key Questions: Law Enforcement
Is the child safe?
Did a crime occur, per the Penal Code?
Is the alleged perpetrator safe in the community?

17. Sexual Behaviors
Research has also demonstrated a consistent relationship between sexual abuse and sexual behaviors in pre-adolescent children.
HOWEVER, a broad range of sexual behaviors has been observed in children who do not have a history of sexual abuse.
Important to be aware of what is normal sexual development, including related behaviors, interactions, and feelings for the growing child!

18. Exercise: Sexual Behavior Cards
What do you think is:
NATURAL/HEALTHY,
PROBLEMATIC/ OF CONCERN,
or ABUSIVE/ SEEK PROFESSIONAL HELP?

19. When do sexual behaviors need to be addressed?
Is the behavior putting the child at risk for physical harm, disease or exploitation?
Is the behavior interfering with the child’s development, learning, social or family relationships?
Is the behavior violating a rule?
Is the behavior causing the child to feel confused, embarrassed, or bad?
Is the behavior causing others to feel uncomfortable?
Is the behavior abusive because it involves lack of informed consent, some type of coercion or lack of equality?

20. Importance of Context
Observers of children’s normal sexual behaviors note:
It is curious in nature;
Children involved in normal sex play are generally of similar age, size, and developmental status;
Children participate on a voluntary basis;
It is balanced by curiosity about other aspects of their lives;
Does not usually leave children with deep feelings of anger, shame, fear, or anxiety;
The affect of children regarding their sexual behavior is generally light-hearted and spontaneous.

21. Adolescent Sexual Experience Quiz
What do you know?
Are these statements TRUE or FALSE?

22. Child Sexual Abuse in a Cultural Context
Acceptance and manifestation of sex and sexuality within cultures
Appropriate and inappropriate sexual behaviors and participants
Sanctions
Sexual orientation, gender identification
Assignment of responsibility and/or “blame”

23. Cultural Aspects of Shame in Child Sexual Abuse
Responsibility for the abuse
Failure to protect
Fate
Damaged goods
Virginity
Predictions of a shameful future
Promiscuity, homosexuality, sexual offending
Re-victimization
Layers of shame

24. Gender & Sexual Orientation Issues
Double standard for males and females
Sexual orientation

25. Elements to consider in Identifying Child Sexual Abuse
Commonly referred to as “indicators”
Four broad areas:
Reporting (including aspects of the allegation and disclosure);
Physical (including medical indicators);
Behavioral (including emotional indicators for the victim); and
Familial (including family and caregiver dynamics)

26. Presence of Indicators ≠ Abuse
Remember. . .
Presence of Indicators ≠ Abuse

27. Reporting Elements Credibility of the report (and the reporter)
Type and credibility of the child’s disclosure
Corroboration of disclosure/report
Statements about prior unreported sexual abuse
History of CWS involvement

28. Physical Elements Presence of illness or injury (ies)
Report of past illness or injury (ies)
Explanation of illness or injury (ies)
Developmental abilities of alleged victim
Developmental abilities of alleged perpetrator
Medical assessment findings

29. Physical Elements: Medical Assessments
When?
In all cases in which the most recent episode of abuse/assault occurred within the last 72 hours
When penetration is disclosed, regardless of time
To assess any injury/pain/physical complaints of the child
When the child would benefit from a medical opinion
Know your county’s protocols!

30. Behavioral Elements
History of sexually abusive behavior by someone in the home or with access to the child
Developmentally or socially inappropriate sexual knowledge and/or sexual behavior by alleged victim
Self-protective behavior by alleged victim
Indicators of emotional distress by alleged victim
Coaching or grooming behaviors

31. Behavioral Elements: Emotional Distress
Trauma-related indicators:
Physiological reactivity/Hyperarousal (hypervigilance, panic and startle responses, etc.)
Retelling and replaying of trauma and post-traumatic play
Intrusive, unwanted images and thoughts and activities intended to reduce or dispel them
Sleeping disorders with fear of the dark and nightmares
Dissociative behaviors (forgetting the abuse, placing self in dangerous situations related to the abuse, inability to concentrate, etc.)

32. Behavioral Elements: Emotional Distress
Anxiety-related indicators
Obsessive cleanliness
Self-mutilating or self-stimulating behaviors
Changed eating habits (anorexia, overeating, avoiding certain foods)

33. Behavioral Elements: Emotional Distress
Depression-related indicators:
Lack of interest in participating in normal physical activities, loss of pleasure in enjoyable activities
Social withdrawal and the inability to form or to maintain meaningful peer relations
Profound grief in response to losses of innocence, childhood, and trust in oneself, trust in adults
Suicide attempts
Low self-esteem, poor body image, negative self-perception, distorted sense of one’s own body

34. Behavioral Elements: Emotional Distress
Other indicators:
Personality changes
Temper tantrums
Running away from home
Premature participation in sexual relationships
Aggressive behaviors
Regressive behaviors in young children (thumb sucking or bedwetting)
Poor school attendance and performance
Somatic complaints
Accident proneness and recklessness

35. Familial Elements
Isolation of the child (inhibits reporting and makes child more vulnerable)
Coercion/threats made to the child to prevent disclosure
Current caregiver’s substance abuse
Opportunity for the abuse to occur

36. Myths and Facts about the Forensic Medical Examination
The medical examination will confirm if there was sexual abuse.
If sexual abuse occurred, there will be findings.
Exams can confirm if a girl is a virgin or not.
The examination will likely be traumatic for the child.
The exam mimics an adult gynecologic exam.
If a child’s pediatrician did an exam, that is sufficient.

37. Myths and Facts about the Forensic Medical Examination
The medical examination will confirm if there was sexual abuse.
Myth
If sexual abuse occurred, there will be findings.
Exams can confirm if a girl is a virgin or not.
The examination will likely be traumatic for the child.
The exam mimics an adult gynecologic exam.
If a child’s pediatrician did an exam, that is sufficient.

38. A View From The Shadows
Johnny’s Story

39. Sgroi’s Five Stages in CSA
Engagement
Sexual interaction
Secrecy
Disclosure
Suppression

40. Summit's Child Sexual Abuse Accommodation Syndrome
Secrecy
Hopelessness
Entrapment and accommodation
Delayed, conflicting, and unconvincing disclosure
Retraction

41. in Johnny’s disclosure?
How do we see Sgroi’s Stages and Summit’s Child Sexual Abuse Accommodation Syndrome
in Johnny’s disclosure?

42. What Is the Evidence? Child Disclosures of Sexual Abuse
Summary of Research Findings:
(Olafson & Lederman, 2006)
Majority of CSA victims do not disclose their abuse during childhood;

43. Olafson & Lederman (2006), cont’d
2. When children do disclose sexual abuse during childhood, it is often after long delays.
3. Prior disclosure predicts disclosure during formal interviews.
4. Gradual or incremental disclosure of child sexual abuse occurs in many cases, so that more than one interview may become necessary.
5. Experts disagree about whether children will disclose sexual abuse when they are interviewed. However, when both suspicion bias and substantiation bias are factored out of studies, studies show that 42% to 50% of children do not disclose sexual abuse when asked during formal interviews.

44. Olafson & Lederman (2006), cont’d
6. School-age children who do disclose are most likely to first tell a caregiver about what happened to them.
7. Children first abused as adolescents are most likely to disclose than are younger children, and they are more likely to confide first in another adolescent than to a caregiver.
8. When children are asked why they did not tell about the sexual abuse, the most common answer is fear. Recantation rates range from 4% to 22%.
Lack of maternal or paternal support is a strong predictor of children’s denial of abuse during formal questioning.
Many unanswered questions about children’s disclosure patterns remain, and further multivariate research is warranted.

45. Olafson & Lederman (2006), cont’d
Additional factors that affect children’s disclosure of sexual abuse:
Abuse by a family member may inhibit disclosure;
Dissociative and post-traumatic symptoms may contribute to non-disclosure;
Modesty, embarrassment, and stigmatization may contribute to non-disclosure; and

46. Non-Offending Parent/Caregiver Reactions
Reactions you may see:
Denial
Anger
Bargaining
Depression
Resolution
BUT- Change and movement between the reactions can happen and will!

47. Why don’t moms believe? Anger Disbelief Denial Shame Guilt Self-blame
Hurt
Betrayal
Confusion and doubt
Own abuse history
Jealousy
Sexual inadequacy or rejection
Minimization
Revenge
Financial or other fears
Religious concerns
Protect perpetrator
Hatred
Repulsion

48. Why don’t moms protect? Behaviors can be viewed on a continuum:
Knows nothing
Has knowledge and does nothing
Recognizes potentially abusive behaviors, ineffectual or no protection
May “sense” something isn’t right, but doesn’t ask
Recognizes potentially abusive behaviors, acts to reduce risk or intervene

49. Why don’t moms protect?
Growing evidence shows when mothers are incapacitated in some way children are more vulnerable to abuse. This may take a variety of forms:
Absent due to divorce, sickness, or death;
Emotional disturbances, psychologically absent;
Their own intimidation, fear, or abuse;
Large power imbalance with perpetrator undercuts her ability to be an ally for her children.

50. Perpetrator Dynamics
Rule 1: They don’t look or act the way you’d expect
-No profile of offender
-Have a public self vs. private self
Rule 2: The rules of logic do not apply
- Need-based cognitive distortions
- They come to believe their own distortions

51. Perpetrator Continuum
Situational:
Do not have a true preference for children
May molest for a wide variety of reasons
More likely to be aroused by adult pornography
Frequently molest readily available children that they have easy access to
Victims young, vulnerable, accessible, less likely to be believed, easy to manipulate or threaten

52. Perpetrator Continuum
Preferential:
Primary sexual orientation is toward children
Over represented in the higher SES groups
Behavior tends to be scripted, compulsive, and primarily fantasy-driven.
More specific sexual preferences as to age, gender, body type
Pornography usually focuses on the themes of their sexual preference (children)
Refer to Behavioral Analysis of Sex Offenders Handout

53. TRUTH, LIES, & SEX OFFENDERS

54. Finklehor’s Four Pre-Conditions to CSA
Motivation of the perpetrator to sexually abuse.
Internal inhibitors against acting out abuse.
External inhibitions against acting out abuse.
Resistance of the child to the attempted abuse.

55. Information Gathering (Tab 3, pages 61 – 63)
Goals
Methods
Training
Documentation
Child
Welfare
Information gathering; safety and risk assessment; protective capacity; case management; court proceedings
Engagement, empathic, strength-based
Social work
Written summary
Forensic
Objective fact-finding for legal proceedings and for all members of MDIT
Child: Research-based protocols;
Adults: Varies from empathetic to confrontational
Specialized
Detailed written,
Signed statements, audiotape or videotaped
Clinical
Information gathering for psychosocial assessment & treatment
Empathic, strength-based, subjective, unstructured, supportive
Brief notes, confidential 55 55

56. Information Gathering with a Child (Child Welfare Perspective)
Who
Where (body parts, geographical)
What
How
Documentation
Clarification
Closure
Explanation of next steps 56 56

57. What is a Forensic Interview?
A forensic interview is conducted with the expectation that it will become part of a court proceeding.
It is intended for a judicial audience and governed by rules of evidence.
Its goal is to obtain facts for a court trial or hearing.
The forensic interviewer strives to:
maintain a neutral and objective stance, to facilitate the child’s recall of previous events they witnessed or experienced.
To ascertain the child’s competence to give accurate and truthful information.

58. Examples of General Questions
Which is better?
Do you know why you’re here today? or
Tell me why you’re here today.
Do you know why we’re talking today?
Tell me why we’re talking today.

59. Avoid These Questions!
Leading (The answer to the questions is quite clear in the question itself)
Your mother rubs your private parts, doesn’t she?
Coercive Statements (Interviewer offers the child something in return for an appropriate response)
You can’t go home until you tell me who did this.
If you tell me who did this to you, I’ll buy you some ice cream.

60. Information Gathering: Child Victims (also refers to section on Impact of Abuse)
Guilt
“Damaged Goods” belief
Blurred physical boundaries
Sexualized behaviors
Ability to say “NO”
Difficulty in talking about ‘taboo’ material
Embarrassment, shame, anger, fear
Location of interview
Degree of privacy
Rapport with interviewer
Previous decision to disclose
Questioning style of the interviewer
Presence of a witness (supportive or otherwise)
Response of other adults to previous disclosures of maltreatment

61. Information Gathering: Non-Offending Parent
Expect denial, disbelief, minimization, projection of blame and possibly hostility toward you;
Choose interview location where perpetrator has little or no power;
Explore observations, time frames, relationships, mental health issues (depression), use of medications, sexual abuse/activity history; possibility of DV/ emotional abuse, support system, etc.;
Prepare for it to take some time before attitude or belief changes.

62. Information Gathering: Non-Offending Parent
Assess dependency issues; drug/alcohol use
Assess ability to emotionally support child or children;
Anything you tell them, you need to provide in writing;
Assess ability to carry through safety plan and investigative requirements (willingness and/or cognitive or logistical ability);
Be prepared to allow ventilation time;
Always leave the door open for further conversations;
Really LISTEN to what their primary concerns are.

63. Issues With Non-Abused Siblings
May be angry with victim for telling (decisional balance) and the consequences of disclosure;
May develop negative behaviors or withdrawal as they cope with situation;
Parent/s may develop and enforce rules to reduce the risk of sibs being victimized, causing resentment and rebellion;
Need to be included in any treatment plan.

64. Information Gathering: Perpetrator
Law enforcement involvement;
Who, where, what are you interviewing for?
Denial 1st response
Minimization of behaviors
Justification
Blame onto victim or spouse
“Sick and sympathy”

65. Welcome Back! Questions, Comments, Clarifications…
Day Two
Welcome Back!
Questions, Comments, Clarifications…

66. Assessment Physical and Behavioral Indicators Child’s Disclosure
Evidence Discovery
Collateral Information
Child/ Family/ Perpetrator History
Alternative Hypotheses/ Confirmatory Bias
Source Monitoring
Perpetrator Admission or Confession

67. Cultural Considerations
What is the general cultural perception of the act/s?
How best to structure approach to child and family
Relationship with authority/government entities
Shame for the child, parent/s, community
Language proficiency, taboo topics or words

68. Analyzing the Child’s Statement
Multiple events/elements of progression;
Explicit sexual knowledge
Richness of details/idiosyncratic details
Internal logic/feasibility
Secrecy
Presence of pressure, coercion, enticement
Child’s perspective of events*

69. Alternative Hypotheses
Reasonable alternative explanations for what the child is describing or other elements uncovered through the investigative process.

70. Validation of the Referral
Looking at the totality of the information gathered from all sources, does it:
Fit professional knowledge of dynamics of child sexual abuse?
Is there a secondary gain for one of the principals?
Is there medical validation/ support?
Is there physical evidence to support allegation?
Is there prior history?

71. The Impact of Sexual Abuse
One child’s voice

72. Information Gathering: Child Victims (also refers to section on Impact of Abuse)
Guilt
“Damaged Goods” belief
Blurred physical boundaries
Sexualized behaviors
Ability to say “NO”
Difficulty in talking about ‘taboo’ material
Embarrassment, shame, anger, fear
Location of interview
Degree of privacy
Rapport with interviewer
Previous decision to disclose
Questioning style of the interviewer
Presence of a witness (supportive or otherwise)
Response of other adults to previous disclosures of maltreatment

73. Case Management Considerations
Separating the Family
Perpetrator from family
Child/children from family
Collaboration and Monitoring
Multidisciplinary team functioning
Developing and monitoring treatment plan/s
Visitation/ Reunification
If, when, and how

74. Treatment Considerations for Victims
Treatment Approaches
Supportive
Symptom-focused
Abuse focused
Visit this website for Evidence Based Practice:
Treatment Issues
Foster healthy expression of feelings related to abuse
Reframe/correct distorted thinking about the abuse
Assist the child in understanding nature and impact of abuse
Reduce behavioral symptoms and emotional distress
Sex education; assertiveness; self-esteem; empowerment; personal safety

75. Treatment Issues for the NOP
Treatment Approaches
Supportive
Psychoeducational
Abuse-focused
Treatment Issues
Enhance Safety/Reduce Risk!
Believe abuse occurred
Hold perpetrator responsible
Empathy/ support for child
Identification of their own role in abuse
Resolution of own abuse/victimization issues
Foster independence

76. Treatment Issues for Perpetrator
Treatment Approaches
Cognitive
Behavioral
Relapse prevention
Offense-specific
Treatment Issues
Accept responsibility for behaviors
Develop/demonstrate empathy for victims and others
Modification of thinking errors/cognitive distortions
Identify and reduce/control deviant sexual arousal
Resolution of own childhood abuse/victimization

77. Time to see what you have learned so far!
Embedded Evaluation
Time to see what you have learned so far!

78. Closure
THANK YOU AND GOOD LUCK TO YOU IN YOUR CHILD WELFARE WORK WITH CHILDREN AND THEIR FAMILIES.