Research participants telling the truth about their lives: the ethics of asking and not asking about abuse

Most discussions of the ethics of self-report research on abuse and interpersonal violence focus on the risks of asking participants about their experiences. An important element of the cost-benefit analysis--the costs of not asking about child abuse--has largely been ignored. Furthermore, little research has been conducted on the costs and benefits of child abuse research, leaving researchers to make decisions based on individual beliefs about such issues as the prevalence of abuse, the likelihood of disclosure, the effects of child abuse, and the ability of abuse survivors to give informed consent. The authors suggest that these beliefs tend to overemphasize survivors' vulnerability and ignore the costs of avoiding asking about abuse. In fact, these beliefs may reinforce societal avoidance of abuse and ultimately harm abuse survivors.     

Prevention of child abuse and neglect

With the dramatic increase in recent reports of physical and sexual child abuse and neglect, professionals are well as the public are increasingly concerned about the prevention of child abuse. This article provides an overview of existing child abuse prevention programs (physical abuse and sexual abuse programs are treated separately). Five computerized data bases (psychology, social work, criminal justice, education, and social sciences) were searched for literature published between 1982 and 1991. We also call attention to critical issues that need to be considered in the development and planning of future prevention efforts and evaluations.     

The assessment of child abuse potential and the prevention of child abuse and neglect: A policy analysis

A frequently advocated strategy for increasing the efficiency of child abuse prevention programs is to deliver prevention services to "high-risk" populations. This article critically reviews procedures for the reliable and valid assessment of child abuse potential within an ecological perspective. Factors that limit the usefulness of child abuse risk assessment are discussed. These factors include the uncertain criteria of child abuse and neglect, the low base rate of the phenomenon, and the financial and social costs of such procedures. Finally, the prevention implications of the current and future state of the art in child abuse risk assessment are considered and preventive interventions that do not depend on individual case risk screening are advocated.     

Adjunct Prenatal Testing: Patient Decisions Regarding Ethnic Carrier Screening and Fluorescence In Situ Hybridization

Little has been reported regarding how women make decisions about genetic carrier screening for Ashkenazi Jewish genetic disease and cystic fibrosis (CF), and for fluorescent in situ hybridization (FISH) during pregnancy. Thirty-seven women who underwent genetic counseling and prenatal diagnosis were interviewed about their prenatal decision making. Respondents were largely Caucasian (95%), and undergoing prenatal diagnosis because of maternal age (78%). Sixty-three percent of those who reported having genetic carrier screening correctly defined it; 83% felt positively about it. Primary reasons reported for electing screening were: to get information, to be prepared, perception of risk, wanting peace of mind and percieved inability to care for an affected child. Women who declined screening felt they had very little or no risk, and some were deterred by cost. Ninety-five percent of respondents elected to have FISH; most were motivated by its speed in providing information and peace of mind or by timing of when the procedure was performed. Those who declined FISH reported being less concerned about having an affected child, receiving bad news, or waiting 2 weeks for results and slightly less affected by their feelings toward medical testing or physician's suggestion. These findings suggest decision-making factors differ between those electing and declining adjunct prenatal testing and increased knowledge about these factors may impact the way in which these services are offered by health care professionals. Prospective research with a larger population will be useful in further delineating the factors that influence prenatal decisions about adjunct testing measures.     

Problem and program linkage: The early and periodic screening,diagnosis and treatment program as a means of preventing and detecting child abuse

This paper presents a case model for linkage of social service delivery programs with the prevention and detection of child abuse. The example of problem and problem linkage is given for the Early and Periodic Screening, Diagnosis and Treatment Program (EPSDT), the nation's largest preventive child health screening program designed to detect and treat early childhood medical and developmental conditions in indigent children. The screening activities combined with the efforts to educate parents as to the nature of normal child development suggests that the EPSDT program may be used to prevent the development of conditions that may lead to abuse as well as to identify children who have been abused.     

The role of corroborative evidence in child sexual abuse evaluations

Published studies of forensic child sexual abuse (CSA) evaluations by mental health and medical professionals and paraprofessionals (MHPs) were analysed in order to evaluate two widely held assumptions. These related assumptions are (1) evidence that corroborates children's reports of sexual abuse is rare in forensic CSA evaluations; and (2) in the vast majority of evaluations, MHPs base their judgements about whether or not sexual abuse allegations are true on their assessments of children's reports of sexual abuse and other psychosocial data. Data from five chart review studies of a combined total of 894 forensic CSA evaluations provided sufficient information to assess the validity of these assumptions. Corroborative evidence was present in 36% of the 894 evaluations and in 54% of evaluations in which MHPs judged the allegations likely to be true, contradicting the first assumption. In the evaluations in which corroborative evidence was present, the presence or absence of a child's report of sexual abuse was only weakly associated with MHPs' judgements about the validity of the allegations (allegations in almost all corroborated cases were judged likely to be true, even in the absence of a child's report), partially contradicting the second assumption. Implications of this analysis for research and policy are discussed. Copyright © 2010 John Wiley & Sons, Ltd.     

Cost–benefit estimates for early intensive behavioral intervention for young children with autism—general model and single state case

Clinical research and public policy reviews that have emerged in the past several years now make it possible to estimate the cost–benefits of early intervention for infants, toddlers, and preschoolers with autism or pervasive development disorder—not otherwise specified (PDD—NOS). Research indicates that with early, intensive intervention based on the principles of applied behavior analysis, substantial numbers of children with autism or PDD—NOS can attain intellectual, academic, communication, social, and daily living skills within the normal range. Representative costs from Pennsylvania, including costs for educational and adult developmental disability services, are applied in a cost–benefit model, assuming average participation in early intensive behavioral intervention (EIBI) for three years between the age of 2 years and school entry. The model applied assumes a range of EIBI effects, with some children ultimately participating in regular education without supports, some in special education, and some in intensive special education. At varying rates of effectiveness and in constant dollars, this model estimates that cost savings range from $187,000 to $203,000 per child for ages 3–22 years, and from $656,000 to $1,082,000 per child for ages 3–55 years. Differences in initial costs of $33,000 and $50,000 per year for EIBI have a modest impact on cost–benefit balance, but are greatly outweighed by estimated savings. The analysis indicates that significant cost-aversion or cost-avoidance may be possible with EIBI. © 1998 John Wiley & Sons, Ltd.     

WHAT INFLUENCES BELIEVING CHILD SEXUAL ABUSE DISCLOSURES? THE ROLES OF DEPICTED MEMORY PERSISTENCE, PARTICIPANT GENDER, TRAUMA HISTORY, AND SEXISM

This vignette study investigated factors that influence believing child sexual abuse disclosures. College student participants ( N = 318) in a university human subject pool completed measures about their own trauma history and responded to questions about sexist attitudes. Participants then read vignettes in which an adult disclosed a history of child sexual abuse, rated disclosures for accuracy and believability, and judged the level of abusiveness. Continuous memories were believed more than recovered memories. Men believed abuse reports less than did women, and people who had not experienced trauma were less likely to believe trauma reports. Gender and personal history interacted such that trauma history did not impact women's judgments but did impact men's judgments. Men with a trauma history responded similarly to women with or without a trauma history. High sexism predicted lower judgments of an event being abusive. Hostile sexism was negatively correlated with believing abuse disclosures. Results are considered in light of myths about child sexual abuse.     

Forming a Consortium: A Design for Interagency Collaboration in the Delivery of Service Following the Disclosure of Incest

A central issue in the treatment of intrafamilial sexual abuse is the "secondary trauma" experienced by both the victimized child and her family when the wider system of regulatory and treatment agencies present redundant, incongruent, or conflicting perspectives and demands. This article describes an attempt to effect second-order change through formation of a consortium of regulatory and treatment agencies to develop a consistent and coordinated response to the disclosure of sexual abuse. Feminist, social constructionist, and organizational development ideas are used to develop principles of intersubjectivity, collaboration and a "both-and" stance, which have guided both the clinical and wider systems work.     

Child sexual abuse evaluations: the scientist–practitioner model

The scientist-practitioner model is presented as a format for conducting child sexual abuse evaluations. This model bases conclusions on empirically established relationships between data and the behavior of interest, rather than on subjective opinions. Using empirically derived evidence, the scientist-practitioner defines child sexual abuse as a life event rather than a clinical syndrome, relies on base rates of behavior for distinguishing and understanding differences between nonsexually abused and sexually abused children, and considers issues of instrument sensitivity and specificity when utilizing assessment tools in child sexual abuse evaluations. This model enlists safeguards to keep the evaluator from inappropriately forming cause and effect associations between a child's single response (e.g., behavioral and emotional symptoms, interactions with anatomically detailed dolls, drawing genitalia) and the occurrence of an event (e.g., sexual abuse). © 1998 John Wiley & Sons, Ltd.     

Simulated judicial decision-making for African and European American adolescents with illegal sexual behavior: The impact of medical data and victim race/ethnicity

The perceived importance of victim and defendant race/ethnicity and medical evidence in child sexual abuse cases has been recognized separately in the literature. However, few studies have considered these factors simultaneously. Within a sample of 880 college students, an interaction effect was tested between the presence of medical evidence and the race/ethnicity of a juvenile defendant and victim using child sexual abuse case vignettes. The main effects of medical evidence and the race of the defendant were observed. Medical evidence and race of victim influenced victim believability such that medical evidence was more impactful for cases with African American victims. Further, there were interactions between the race of the defendant and the race of the victim in adult versus juvenile court decisions, sex offender registration and notification requirements, and length of sex offender registration and notification. Interracial sexual offending was associated with substantially higher punishment than intraracial sexual offending. Accordingly, several important implications for court-level decision-making processes are explored.     

Societal Burden of Clinically Anxious Youth Referred for Treatment: A Cost-of-illness Study

A prevalence-based cost-of-illness study using a societal perspective was conducted to investigate the cost-of-illness in clinically anxious youth aged 8–18 in The Netherlands. Discriminant validity of the cost diary used was obtained by comparing costs of families with an anxious child (n = 118) to costs of families from the general population (n = 41). To examine the convergent validity, bottom-up acquired costs derived from cost diaries were compared to top-down acquired costs obtained from national registrations. Bottom-up acquired costs measured by means of cost diaries amounted to €2,748 per family of a clinically referred anxious child per annum. Societal costs of families with clinically anxious children were almost 21 times as high compared to families from the general population. With respect to convergent validity, total health care costs using the bottom-up approach from clinically anxious children were quite comparable to those of top-down data of anxious children, although costs within the subcategories differed considerably. Clinical anxiety disorders in childhood cost the Dutch society more than 20 million euros a year. Based on results of discriminate and convergent validity, the cost diary seems a valid method in establishing cost-of-illness in childhood anxiety disorders.     

A Rejection Threshold in Justice Evaluations: Effects on Judgment and Decision-Making

This research examined the process through which justice evaluations are formed. Using image theory's screening process we hypothesized that a rejection threshold exists with regard to violations of just treatment (e.g., laying off an employee without notice). If the number of violations exceeds the decision-maker's threshold, a negative justice evaluation results. Nonviolations (e.g., providing laid-off employees with a generous severance package) were hypothesized to only influence justice evaluations when violations do not exceed the threshold. Three studies compared the impact of justice violations and nonviolations on fairness evaluations. We also examined differences in fairness evaluations operationalized as judgments vs decisions. Results indicated that when makingjudgmentsabout fairness, both violations and nonviolations are equally important. However, when one has todecideon a course of action based on considerations of fairness, nonviolations are only considered if fewer than three violations have been encountered. These results identify important distinctions between judgment and decisions and have implication for research examining outcomes of justice evaluations.     

Outpatient Clinic Identification of Trauma Symptoms in Children in Foster Care

As understanding of the impact of trauma on children has grown, there has been increasing interest in the use of screening the medical setting to identify which children at risk may be symptomatic. This study was undertaken to determine whether the use of a trauma assessment tool to screen for trauma symptoms in the setting of a foster care clinic was feasible and more sensitive than non-standardized approaches in the context of outpatient primary care. Using a chart review of trauma symptom identification before and after the implementation of the Trauma Symptom Checklist for Children (TSC-C) and the Trauma Symptom Checklist for Young Children (TSC-YC), validated trauma assessment tools, we looked at the feasibility of use of this tool and likelihood of trauma symptom identification. 73 % (n = 204) of eligible patients had a trauma screening tool in the medical record following the introduction of the use of the TSC. Detection of trauma symptoms was higher in the screening period than in the baseline period for the entire population (78 vs. 46 %, p < 0.0001), and trauma symptoms were identified with more specificity following the introduction of, and likely due to, formal trauma screening. However, there were limitations as to feasibility in the outpatient medical clinic. In conclusion, the use of the TSC-C and TSC-YC in the setting of an outpatient foster care evaluation clinic increased rates and precision of identification of trauma symptoms, but had limitations to its feasibility of use in the outpatient clinic setting.     

Sticks and Stones May Break My Bones but Words Relate to Adult Physiology? Child Abuse Experience and Women's Sympathetic Nervous System Response while Self-Reporting Trauma

Child abuse predicts a wide range of long-lasting deleterious outcomes, including disruptions in the biological systems central to emotion arousal and regulation. However, little is known about the specific ways in which child abuse affects adulthood sympathetic reactivity and recovery. This study investigated the association between child abuse experience and adult skin conductance level and habituation in 85 at-risk women as they completed a self-report trauma questionnaire. Childhood emotional abuse was independently associated with blunted skin conductance habituation over the course of survey completion after controlling for other abuse subtypes and current trauma symptoms. These results suggest that women emotionally abused as children experience prolonged emotional arousal and poor physiological regulation of emotion in response to reminders of traumatic experiences.     

HPA-Axis Activation as a Key Moderator of Childhood Trauma Exposure and Adolescent Mental Health

Individual differences in a child’s sensitivity to stress may influence whether youth exposed to trauma develop symptoms of psychopathology. We examined the interaction between HPA-axis reactivity to an acute stressor and exposure to different types of childhood trauma as predictors of mental health symptoms in a sample of youth. Youth (n?=?121, ages 9–16; 47% female) completed a standardized stress task, including 5 post-stress salivary cortisol samples. Parents also completed the Child Behavior Checklist as a measure of child internalizing and externalizing symptoms in the past month, and completed the Early Trauma Inventory (ETI) as a measure of their child’s trauma exposure. More emotional abuse and non-intentional trauma were associated with greater internalizing symptoms. Youth exposed to physical abuse who demonstrated slower HPA-axis reactivity had elevated internalizing and externalizing symptoms. Youth exposed to emotional abuse or non-intentional traumatic events who demonstrated faster HPA-axis reactivity had elevated internalizing and externalizing symptoms. Profiles of exaggerated or attenuated HPA-axis reactivity to acute stress may be risk factors for psychopathology in children facing different stressful social environments.     

Relational Diagnosis and Psychotherapy Treatment Cost Effectiveness

Despite a call by researchers for estimates of the treatment effectiveness and cost effectiveness for relational problems, very little has been done to answer this call. The present study is an examination of actual treatment costs and recidivism rates for patients treated for a relational problem (either in individual or conjoint therapy sessions) in the Cigna network. Policymakers and third-party payers may use such clinical-effectiveness and cost effectiveness data to make decisions regarding treatment of relational problems and funding allocation. The present study is also the first to compare the costs of couples therapy versus family therapy for relational problems.     

Prior Trauma Exposure for Youth in Treatment Foster Care

Very little research has focused on rates of trauma exposure for youth in treatment foster care (TFC). Available research has utilized record review for assessing exposure, which presents limitations for the range of trauma types examined, as records are predominantly focused on abuse and neglect. The current study examines exposure rates and association with emotional and behavioral outcomes for 229 youth in 46 TFC agencies. The youth in this study had exceptionally high rates of trauma exposure by foster parent report, similar to youth in traditional foster care, with nearly half of the sample exposed to four or more types of traumatic events. A composite child abuse and neglect exposure variable was associated with child and adolescent emotional and behavioral outcomes. Implications for services provided as part of TFC are discussed.