Child sexual abuse: Raising awareness and empathy is essential to promote new public health responses

Effects of a Violence Prevention Education Program Using Empathy (VPEP-E) on Fifth-Grade Students in South Korea

This study aimed to investigate the effects of a violence-prevention education program using empathy (VPEP-E) on elementary school students. This quasi-experimental design examined fifth-grade students' (a) empathy level, (b) perception of violence, and (c) permissive and negligent attitudes toward violence, using a pre- and post-test design. A total of 101 students participated: the experimental group (n = 48) received eight sessions of VPEP-E, whereas the control group (n = 53) received violence prevention education through classroom lectures. Significant differences were observed between the groups' empathy level (t = 6.81, p < .001), perception of violence (t = 2.79, p = .006), and permissive and negligent attitudes toward violence (t = -2.21, p = .030; t = -2.02, p = .046). Thus, a school-based VPEP-E may help elementary school students. Long-term studies evaluating behavioral changes from VPEP-E implementation are needed for establishing the effects on violent behavior.

"Pay Attention! Pay Attention! Pay Attention!!!": The Pivotal Role of Educators and the Educational System as Experienced by Survivors of Child Sexual Abuse

Educational institutions and educators are significant in children's lives, and they have a crucial role in implementing policies, practices, and sexual education to enhance children's safety. Such policies and practices should be based on the voices of CSA survivors. This study explored child sexual abuse (CSA) survivors' viewpoints on their past experiences with educators and the educational system. A qualitative thematic approach was used to analyze 61 written testimonies collected in 2020-2021 by the Israeli Independent Public Inquiry on CSA. Two interrelated themes arose: (1) CSA survivors' retrospective perspectives of educators and the educational system's responses to signs of their CSA, described as ranging from abusive to life-saving. Specifically, they shared three types of responses: (a) harmful and hurtful; (b) dismissive and ignoring; and (c) accepting and attending. (2) The second theme described the survivors' messages to educators to promote constructive change. The survivors conveyed expectations that educators should play a central role in CSA prevention, detection, and intervention and, specifically, the need for educators to receive professional training, provide beneficial sexual education, and identify and respond to CSA. The findings promoted moving beyond individual-level interventions to focus on improving educational institutional and organizational cultures related to CSA in both national and international contexts.

'A kindergarten teacher must have 100 eyes and 100 ears!': Kindergarten teachers' experiences coping with child sexual abuse and problematic sexual behavior

BACKGROUND

Child sexual abuse (CSA) and problematic sexual behavior (PSB) are worldwide phenomena that occur across all ages. Kindergarten teachers' proactive involvement can be crucial to the prevention, disclosure and intervention of CSA and PSB. However, research on their experiences of contending with CSA and PSB remains limited.

OBJECTIVE

This study examines kindergarten teachers' experiences in Israel with the CSA and PSB of their students.

PARTICIPANTS AND SETTING

Semi-structured interviews were conducted with 31 teachers: 11 secular Jewish, seven religious Jewish, nine Druze Arab, and four Muslim Arab.

METHODS

A qualitative analysis was conducted using the interview transcripts as data.

RESULTS

The analysis revealed three themes illustrating teachers' professional transformations regarding their knowledge of these phenomena: 1) initial shock, uncertainty and sense of responsibility when exposed to CSA and PSB due to missing knowledge, 2) implementation of prevention and intervention strategies regarding CSA and PSB, and 3) embracing a social role to disseminate CSA and PSB knowledge. The findings indicated that the majority of the teachers went from overwhelming shock and fear due to a lack of knowledge in coping with CSA and PSB to a sense of responsibility as a community leader.

CONCLUSIONS

The fragmentation of the Israeli education system isolates kindergartens, and the lack of training and education for the teachers left them alone when contending with the CSA and PSB of their students. Nevertheless, the participants exhibited remarkable agency and resourcefulness, gaining the necessary knowledge and acting as knowledge agents within their communities.

"Finding My Worth as a Sexual Being": A Qualitative Gender Analysis of Sexual Self-Concept and Coping in Survivors of Childhood Sexual Abuse

Childhood sexual abuse (CSA) is likely to have impacts on adult survivors' sexuality, particularly on their sexual self-concept. However, little is known about how survivors cope with CSA-related sexual impacts, including sexual self-concept impairments. Thus, this study aimed to examine the interplay between sexual self-concept and coping strategies in CSA survivors by (1) documenting the manifestations of their impaired sexual self-concepts; (2) identifying their strategies to cope with the sexual impacts of CSA; and (3) examining gender differences on sexual self-concept impairments and coping strategies. Content analysis was conducted on semi-structured interviews with 25 women and 26 men adult survivors of CSA recruited via social networks and victim support organizations. Analyses yielded three conceptual categories: (1) Developing an unconsolidated and unfavorable sexual self-concept following CSA; (2) Avoiding CSA-related sexual impacts and impaired sexual self-concept; (3) Approaching CSA-related sexual impacts with more authenticity. Men often managed their suffering and compensated for their impaired sexual self-concept by engaging in sexual dominance and over-investment, by accepting their sexual difficulties and relying on medication to overcome them. Women tended to restrict themselves and disconnect sexually to avoid suffering, complied with their partners' sexual demands out of a sense of duty, prioritized sexual intimacy over orgasm, and seek professional help. Interventions with survivors should promote the development of approach strategies to cope with sexual difficulties, including self-concept impairments, and foster sexual authenticity.

Child sexual abuse by different classes and types of perpetrator: Prevalence and trends from an Australian national survey

BACKGROUND

Little evidence exists about the prevalence of child sexual abuse (CSA) inflicted by different relational classes of perpetrators (e.g., parents; institutional adults; adolescents), and by individual types of perpetrators (e.g., fathers and male relatives; male teachers and male clergy; known and unknown adolescents).

OBJECTIVE

To generate evidence of the prevalence of CSA by different perpetrators, and trends by victim gender and age group.

PARTICIPANTS AND SETTING

The Australian Child Maltreatment Study collected information about CSA victimisation from a nationally-representative sample of 8503 individuals aged 16 and over.

METHODS

We analysed data about 42 perpetrator types, collapsed into eight classes. We generated national prevalence estimates of CSA inflicted by each perpetrator class and individual perpetrator type, and compared results by victim gender and age group.

RESULTS

Australian CSA prevalence was 28.5%, with the following prevalence by perpetrator classes: other known adolescents (non-romantic): 10.0%; parents/caregivers in the home: 7.8%; other known adults: 7.5%; unknown adults: 4.9%; adolescents (current/former romantic partners): 2.5%; institutional caregivers: 2.0%; siblings: 1.6%; unknown adolescents: 1.4%. Women experienced more CSA by all perpetrator classes except institutional caregivers. Age group comparison showed significant declines in CSA by parents/caregivers, and other known adults; and increases in CSA by adolescents (current/former romantic partners). Individual perpetrator type comparison showed declines in CSA by fathers, male relatives living in the home, non-resident male relatives, and other known male adults; and increases in CSA by known male adolescents, current boyfriends, and former boyfriends.

CONCLUSIONS

CSA by adults has declined, indicating positive impacts of prevention efforts. However, CSA by adolescents has increased. Further declines in CSA by adults are required and possible. Targeted prevention of CSA by adolescents must be prioritised.

Variables affecting the attitudes of teachers and school principals in reporting child abuse: An analysis of demographic characteristics, awareness, and self-efficacy

BACKGROUND

Teachers and school principals have an important role in the lives of children because they spend so much time with them, creating trusting relationships that make it easier to disclose abuse events. As a result, it's critical to look at the factors that influence teachers' and principals' attitudes towards reporting child abuse.

OBJECTIVE

The purpose of this study was to look at the factors that influence preschool teachers, primary school teachers, and school principals (N = 432) attitudes towards reporting child abuse in a Turkish sample.

PARTICIPANTS AND SETTING

The study comprised 432 participants, including preschool teachers, primary school teachers, and school principals. Seniority, educational levels, knowledge of abuse, awareness of abuse, and self-efficacy were among the criteria considered while analysing the participants.

METHODS

The study employed a survey model to assess the attitudes of the participants. Seniority, educational levels, knowledge of abuse, awareness of abuse, and self-efficacy were all considered predictors of attitudes towards reporting abuse.

RESULTS

The investigation found that elementary school teachers were more likely than other participants to report abuse. The branch of education, awareness of sexual abuse, and self-efficacy were found to be important predictors of attitudes towards reporting abuse in a hierarchical analysis. The complete study report will include specific effect sizes and their statistical significance.

CONCLUSIONS

The findings of this study contribute to a better understanding of the factors influencing teachers' and principals' attitudes towards reporting child abuse in Turkey. Primary school teachers had more favourable attitudes, with the education branch, awareness of sexual abuse, and self-efficacy emerging as important predictors.

Cultural Determinants and Parent-Child Communication as an Effective Tool to Prevent Child Sexual Abuse: A Quick Qualitative Study

The current study's sole specific goal was to use a qualitative approach, from the parents' emic perspective, to investigate the cultural determinants that influence using parent-child communication as an instrument to protect children from sexual abuse in the six electoral wards of Ife-East Local Government that covered the rural settlement of Ile-Ife. The study adopted a simple random sampling method to select a village from each ward and a convenient sampling method to select six parents from each village, making a total sample size of 36. The study utilized in-depth face-to-face interviews to garner the primary data and content analysis for data analysis. This study found and concluded that parents' economic activities, religious beliefs, fear of stigmatization or mockery, belief that giving a child sex education via parent-child communication promotes waywardness in the behavior of such a child, belief that sex education should be best confined to formal education, and overconfidence of the parents in their wards were among the cultural determinants influencing the efficacy of parent-child communication as a device to shield young ones from being victims of sexual abuse in the study location. The study recommended public enlightenment via various social institutions on dealing with these cultural determinants.

Trends in public interest in child abuse in the United States: An infodemiology study of Google Trends from 2004 to 2022

INTRODUCTION

More than 1 in 7 children in the United States experience abuse annually with rates remaining consistent over the past 2 decades. During this timeframe, several high-profile cases of child abuse and neglect were publicized in national media in addition to multiple investigations uncovering Indigenous children dying from abuse at Indian Boarding Schools. Increased media attention among other public health and medical topics has been linked to increased public interest, thus, our objective was to investigate trends in public interest from 2004 to 2022.

METHODS

To assess trends in public interest, we extracted monthly relative search interest in child abuse from Google Trends. We constructed linear regression to determine the long-term trajectory of interest, and also compared the slope of the trend to other topics, such as domestic violence. Further, we compared mean relative search interest (RSI) from Child Abuse Awareness Month (April) to other months via t-test. Lastly, we assess by-state correlations of RSI and number of children abused.

RESULTS

Since 2004, search interest in child abuse has significantly declined in the United States-more than other related search terms. Child Abuse Awareness Month showed spikes in RSI which were greater than other months. By-state correlations of RSI and abuse were moderate to weak.

CONCLUSION

Despite heavy media attention covering stories of child abuse during the past 2 decades, search interest in child abuse has significantly declined. This trend may be related to aversion to secondary traumatic stress as news broadcasts often include stories of violence-of which child abuse stories may be most provoking. Following journalism guidance from the Centers for Disease Control and Prevention, reporting with focus on resiliency and prevention, rather than the individuals who perpetrated the crime, may provide more community support and increased public interest.

Pediatricians' Attitudes Toward Child Sexual Abuse in the Republic of Srpska

Child sexual abuse (CSA) affects all cultures and sociodemographic sections. As health professionals, pediatricians are often the first line of defense when it comes to CSA identification and reporting. Our previous study examined encounters, competence, beliefs, and reporting regarding CSA among pediatricians in countries of the former Yugoslavia, Serbia, and Montenegro. Following up on this work, we expanded our research to another neighboring country, the Republic of Srpska (RS). Sixty pediatricians were surveyed in 2020, comprising 30% of all practicing pediatricians in the Republic of Srpska. Compared to their colleagues from Serbia and Montenegro, RS pediatricians revealed an increased perception that children are often abused by someone they do know well, were more confident in their abilities to detect CSA, reported a higher number of CSA cases, and were more interested in further trainings on the subject of CSA. Despite this, the level of underreporting remained high (40%). To our knowledge, this is the first study to both assess and compare CSA-related attitudes in this part of the world. Key differences between RS, other two neighboring countries as well as from other countries worldwide are likely to stem from the level of pediatricians' training and education, as well as from the socio-cultural and legislation context. Although encouraging, our data indicate a need for further research in the countries of the former Yugoslavia.

The Role of Theory in the Prevention of Sexual Violence in Sport

Sexual violence (SV) remains at epidemic proportions in the U.S. and growing evidence demonstrates that youth and adults engaged in sport are at increased risk of victimization and perpetration of SV. Unfortunately, sport SV prevention strategies are rarely built on theory or theoretically grounded evidence, despite demonstrated effectiveness of such approaches. This study aimed to answer to questions: 1) Which theories are relevant to the development of effective SV prevention strategies in sport?; and 2) How has theory been incorporated into existing SV prevention literature on sport safety? A scoping review of the literature plus expert input identified 29 theories pertinent to SV prevention in sport. A systemized review of the literature regarding SV prevention in sport resulted in the identification and characterization of 41 published articles. Authors then examined theory's role in prevention literature. This study identified 29 theories pertinent to SV prevention in sports and applicable across the behavioral spectrum. Most theories were rooted in the Behavioral (41%), Situational (24%) or Social/Attitudinal (21%) areas. Less common were theories grounded in Feminist (14%) domains. Theories were predominantly focused at the individual (42%), organizational (29%), and interpersonal (18%) ecological levels. Of the 41 sport prevention articles, 33 (83%) referred to a theory either explicitly or implicitly. Though most theories have been incorporated into prevention efforts, closer examination indicates that the majority were descriptive, unlikely to use a sophisticated methodology (10%; e.g., experimental, quasi-experimental), and rarely intended to assess a specific prevention program/strategy or policy (21%). Strong theoretical foundations are available for SV prevention research focused on sports, and their application appears to show value across the developmental spectrum of athletes. There remains a need for greater focus on theory-driven research intended to develop prevention strategies and policies designed to enhance athlete safety.

Hiding under the Color of Authority: Eric Wess Uller and his Decades-Long Rampage of Child Sexual Abuse

There are uniform characteristics of perpetrators of child sexual abuse; two of which stand out. Perpetrators generally put themselves in positions that provide easy access to children or adolescents, and they exploit the power or authority of those positions to sexually coerce their victims. There are nonetheless characteristics of perpetrators that are assuredly unique. Effectively posing as a police officer, while also claiming to be a medically trained practitioner capable of performing physical examinations, is an example of such. Relying on both of these misrepresentations, Eric Wess Uller grievously sexually abused over ninety underprivileged adolescent boys who were participants in a youth serving organization (YSO). Arrested after a twenty-year rampage, Mr. Uller then killed himself following his release on bail. Though anomalous in some respects, this case is best understood as a vital underscoring of the vulnerability of underprivileged teenage boys. Where the shortcomings of YSO's are concerned, the commitment to vigilance must be sustained irrespective of the hierarchical status of the personnel involved. Policy recommendations, informed by the limitations of diagnostic predictions, are included.

Training for mandated reporters of child abuse and neglect: Content analysis of state-sponsored curricula

BACKGROUND

Child abuse and neglect is a public health concern around the world, with well-established impacts and costs to children, families, and society. While mandated reporters make the majority of reports, child abuse is still under-reported and many mandated reporters fail to report known and suspected cases.

OBJECTIVE

This study was designed to evaluate the content of US state-sponsored online mandated reporter training in order to identify gaps and need for improvement in mandated reporter training.

METHODS

A deductive qualitative content analysis of the publicly available curricula was conducted. Variables coded were identified through a literature review and consultation with experts.

RESULTS

Numerous gaps were identified in the curricula including: few trainings identified reasons why reports should be made, only about one fourth included a definition, indicators, and examples of each type of maltreatment, the average number of suggestions for responding to a disclosure made by a child was 3, and few curricula addressed barriers to reporting or the impact of reporting on the reporter.

CONCLUSIONS

The trainings as a whole are not providing mandated reporters with comprehensive information about definitions, examples, and indicators of the major types of childhood maltreatment. In addition, the trainings contain only limited information to motivate reporters to see their role as part of a collective endeavor to protect children, and they are failing to adequately address reluctance about reporting. However, improvements are readily achievable. A partnership approach to curriculum design and delivery is recommended to develop effective training that will promote sound reporting.

The Integration of People Convicted of a Sexual Offence Into the Community and Their (Risk) Management

PURPOSE OF REVIEW

We are reviewing recent research into the community integration of men convicted of a sexual offence and their (risk) management. This is a high-profile political issue that binds together research in psychology, criminology, politics, health, public health, and policy studies. The review will demonstrate that a multi-disciplinary, life course, EpiCrim-oriented approach is the most effective way of reducing re-offending and promoting desistance in this population.

RECENT FINDINGS

Research demonstrates that life course development, especially from psychology and criminology, has an impact on whether people sexually offend or not. Therefore, to understand sexual offending behaviour, we need to look at the aetiology of said behaviour from a nature and a nurture perspective. Therefore, we need to use an Epidemiological Criminology (a marriage of Public Health and criminology) approach that works at all four stages of the Socio-Ecological Model (SEM) (individual, interrelationship, community, and societal). The research encourages a person first approach, that we look at Adverse Childhood Experiences and past trauma in the lives of men who sexually offend and use this, in conjunction with strength-based approaches, to inclusively integrate them into society. The prevention of sexual offending, both first time offending, and relapse prevention require a multi-level, multi-disciplinary approach. Successful desistance from sexual offending is as much about the community and society as it is about the individual.

Disclosure of non-recent (historic) childhood sexual abuse: What should researchers do?

Non-recent (historic) childhood sexual abuse is an important issue to research, though often regarded as taboo and frequently met with caution, avoidance or even opposition from research ethics committees. Sensitive research, such as that which asks victim-survivors to recount experiences of abuse or harm, has the propensity to be emotionally challenging for both the participant and the researcher. However, most research suggests that any distress experienced is usually momentary and not of any clinical significance. Moreover, this type of research offers a platform for voices which have often been silenced, and many participants report the cathartic effect of recounting their experiences in a safe, non-judgemental space. With regard to the course of such research, lines of inquiry which ask adult participants to discuss their experiences of childhood sexual abuse may result in a first-time disclosure of that abuse by the victim-survivor to the researcher. Guidance about how researchers should respond to first-time disclosure is lacking. In this article, we discuss our response to one research ethics committee which had suggested that for a qualitative study for which we were seeking ethical approval (investigating experiences of pregnancy and childbirth having previously survived childhood sexual abuse), any disclosure of non-recent (historic) childhood sexual abuse which had not been previously reported would result in the researcher being obliged to report it to relevant authorities. We assess this to be inconsistent with both law and professional guidance in the United Kingdom; and provide information and recommendations for researchers and research ethics committees to consider.

Recommendations for Preventing Child Sexual Abuse in Youth-Serving Organizations: Implications From an Australian Royal Commission Review of the Literature

Evidence suggests that tens of millions of children and adolescents are involved in youth-serving organizations (YSOs) outside of their homes on a daily basis. Children's involvement with YSOs clearly offers a broad array of emotional, social, and personal development benefits. This involvement can, however, also be associated with a variety of safety risks, including the potential for child sexual abuse (CSA) victimization and the myriad short- and long-term consequences to its victims and their families. Recognizing the significance of CSA within YSOs, the Australian Royal Commission into Institutional Responses to Child Sexual Abuse funded a comprehensive review of the literature on risk and protective factors related to CSA in institutions. This yielded more than 400 primarily research articles from the United States, United Kingdom, and Australia, examining institutional CSA victims, perpetrators, and settings. Findings were provided regarding six specific types of institutional settings, including faith-based, early childhood education, childcare and schools, health care, out-of-home/foster care, and sport. This article is based on the findings of Kaufman and Erooga's comprehensive literature review and Royal Commission findings. It provides a brief review of critical risks associated with CSA victims, perpetrators, and organizational settings, as well as highlights risks particular to specific types of YSOs and risks that are present across these organizations. Optimal prevention directions and strategies are outlined in response to identified patterns of organizational risk. Recommendations for YSO policy enhancements are also provided to complement the article's prevention focus. Finally, suggestions are offered for future research directions to foster the development of an evidence-based foundation for work in this area.

“The Power of Me”: The Role of Agency in the Resilience Processes of Adolescent African Girls Who Have Been Sexually Abused

In this article we explore how individual expressions of agency are shaped by structural factors and exercised by Black African girls with child sexual abuse (CSA) histories as they navigate resilience pathways. We employed a qualitative multiple instrumental case study design and purposefully recruited seven Black African girls, between the ages of 15 and 18 years, with a history of CSA. Participants were engaged in a range of participatory methods that included participatory diagramming (time lines), digital stories, and participatory videos. Data were analyzed using inductive thematic analysis. Findings highlight how agency, as a process of resilience, manifested as well as how these agentic expressions were activated, bound, and later reciprocated and sustained by the surrounding social structures.

Keeping Students Out of Harm's Way: Reducing Risks of Educator Sexual Misconduct

Sexual misconduct by school staff, which we refer to as educator sexual misconduct (ESM), is a serious and damaging violation of the trust that parents and students put in the educational system. After reviewing the prevalence and consequences of ESM for all parties involved, the authors propose standards of practice based on the Situational Crime Prevention framework to prevent sexual abuse by altering the environment and reducing opportunities for offending. The strategies offered in this paper can help create a comprehensive approach to reducing sexual victimization of students by staff. The standards serve as an operational framework for prevention and reduce the likelihood of ESM and institutional legal liability. The seven standards include safe screening and hiring practices for staff, codes of conduct, ensuring safe environments, staff-student communication policy (including electronic communication), training staff, parents and students, monitoring and supervision, along with reporting questionable conduct. By implementing these standards, educational institutions can help ensure better protection of children from ESM.

Adult Empathy: Possible Gender Differences in Gene-Environment Architecture for Cognitive and Emotional Components in a Large Italian Twin Sample

Empathy plays a central role in prosocial behavior and human cooperation. Very few twin researchers have investigated innate and environmental effects in adult empathy, and twin research on gender differences in these effects is sparse. The goal of this study was to examine innate and environmental influences on three components of an empathy scale frequently used with adults - the expression of cognitive (CE), emotional (EE), and social skills (SS) empathy - and to explore gender differences in the influences. Study participants were ~1,700 twins (18-65 years) enrolled in the Italian Twin Registry. Empathy was assessed with the Italian version of the Empathy Quotient (EQ), for which the three-factor structure (i.e., CE, EE, and SS) was confirmed. Twin correlations in monozygotic and dizygotic pairs, and males and females were estimated for the total EQ and subscale scores, and univariate genetic model fitting was carried out. Women's empathy (i.e., total EQ as well as CE and EE subdimensions) was predominantly driven by genetic factors and individual experiences, whereas for males, no genetic contribution or important shared and individual environmental effects emerged. Although of large magnitude, the gender differences did not reach statistical significance. Age did not moderate empathy heritability in adulthood. Only for the SS subscale were genetic and environmental proportions of variance similar for men and women. This study suggests possible gender-specific innate and environmental influences on empathy and its cognitive and emotional components that need to be confirmed in future studies.

A Model to Promote Public Health by Adding Evidence-Based, Empathy-Enhancing Programs to All Undergraduate Health-care Curricula

Fostering empathy in future health-care providers through service-learning is emerging as central to public health promotion. Patients fare better when their caregivers have higher relationship-centered characteristics such as the ones measured by the Jefferson Scale of Empathy. Unfortunately, these characteristics often deteriorate during health-care professional training. Nevertheless, growing literature documents how we can promote empathy, and other patient-centered characteristics, throughout health-care professional students’ undergraduate education. As for proven treatment plans, we believe we should also use evidence-based guidelines to foster relationship-centered characteristics in our students when training them to practice as part of an interdisciplinary health-care team.

Optimising implementation of reforms to better prevent and respond to child sexual abuse in institutions: Insights from public health, regulatory theory, and Australia's Royal Commission

The Australian Royal Commission Into Institutional Responses to Child Sexual Abuse has identified multiple systemic failures to protect children in government and non-government organizations providing educational, religious, welfare, sporting, cultural, arts and recreational activities. Its recommendations for reform will aim to ensure organizations adopt more effective and ethical measures to prevent, identify and respond to child sexual abuse. However, apart from the question of what measures institutions should adopt, an under-explored question is how to implement and regulate those measures. Major challenges confronting reform include the diversity of organizations providing services to children; organizational resistance; and the need for effective oversight. Failure to adopt theoretically sound strategies to overcome implementation barriers will jeopardize reform and compromise reduction of institutional child sexual abuse. This article first explains the nature of the Royal Commission, and focuses on key findings from case studies and data analysis. It then analyzes public health theory and regulatory theory to present a novel analysis of theoretically justified approaches to the implementation of measures to prevent, identify and respond to CSA, while isolating challenges to implementation. The article reviews literature on challenges to reform and compliance, and on prevention of institutional CSA and situational crime prevention, to identify measures which have attracted emerging consensus as recommended practice. Finally, it applies its novel integration of regulatory theory and public health theory to the context of CSA in institutional contexts, to develop a theoretical basis for a model of implementation and regulation, and to indicate the nature and functions of a regulatory body for this context.

Reports of child sexual abuse of boys and girls: Longitudinal trends over a 20-year period in Victoria, Australia

Although prevalence studies show girls are more frequently sexually abused than boys, a significant proportion of boys also experience child sexual abuse (CSA). The challenges for public policy are amplified for boys due to less developed public and professional sensitisation to boys' experiences, conceptions of masculinity, and less research on boys including into reporting trends and outcomes. We conducted a 20-year longitudinal time-trend analysis of government data to identify reporting trends and report outcomes for CSA in Victoria, Australia from 1993 to 2012. We stratified by child gender and reporter status. Results indicate a new sensitisation to CSA, especially for boys, although this trend was not stable. Marked change occurred in the last five years, likely influenced by major social and political events. Comparison over time revealed that from 1993 to 2012, the rate of reporting of boys increased 2.6-fold whereas there was a 1.5-fold increase for girls. Comparing genders, with regards to rate of reporting, in 1993, the sex ratio of girls to boys was 2:1, while by 2012 this ratio changed to 1.14:1. Reports by police and other mandated reporters accounted for the majority of the increase in reports over the 20-year period, suggesting unequal sensitisation. Positive report outcomes (i.e. substantiations, findings of harm, and referral to services) increased twelve-fold for boys, and nearly five-fold for girls, indicating the increased levels of reports were based in actual clinical need. Most of this increase occurred from 2009 to 2012, influenced by a compound of social, political and agency-related factors.