Multiple Forensic Interviews During Investigations of Child Sexual Abuse: A Cost-Effectiveness Analysis

Economic evaluations of interventions focusing on child abuse and neglect in high-income countries: a systematic review

Introduction

Child abuse and neglect are together considered to be an important public health problem with a high individual and societal burden. Different interventions have been developed to prevent, diagnose, or treat maltreatment. While their effectiveness has been synthesized in prior reviews, the analysis of their cost-effectiveness is less common. The aim of this study is to synthesize and analyse economic evaluations of interventions focusing on child abuse and neglect in high-income countries.

Methods

A systematic literature review was performed using MEDLINE, EMBASE, EconLit, PsycInfo and NHS EED. This study follows the PRISMA guidelines and double scoring was performed. The review includes trial- and model-based economic evaluations of preventive, diagnostic, and treatment related interventions in children up to 18 years or their caregivers. Risk of bias was assessed using the CHEC-extended checklist. The results are presented in a cost-effectiveness plane.

Results

Of 5,865 search results, the full texts of 81 were analyzed, resulting in the inclusion of 11 economic evaluations. Eight of the included studies focus on prevention of child abuse and neglect, one study on diagnosis, and two on treatment. The heterogeneity between studies did not allow for the quantitative pooling of results. Most interventions were cost-effective, with the exception of one preventive and one diagnostic intervention.

Conclusion

This study was subject to some limitations, as no gray literature was included, and the selection of studies may have been arbitrary due to varying terminologies and methodologies in the field. However, the quality of studies was high, and several interventions showed promising results.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021248485, identifier: CRD42021248485.

The Medical Somatic Dissociation Questionnaire Assessment For Childhood Sexual Abuse: A Brief Report

Child sexual abuse is a prevalent phenomenon worldwide. However, a gap exists between its incidence and its disclosure rate. Furthermore, assessment tools and techniques capable to identify the source of symptoms are lacking. This study investigates the extent to which the validated Medical Somatic Dissociation Questionnaire (MSDQ) can differentiate between sexually and non-sexually abused children. A total of 794 children and youth between the ages of 8 and 18 (mean age: 12.2 (SD = 2.3); 42% female, 58% male) were recruited from the general population; other participants were residents of boarding schools and children who were referred to medical treatment. The anonymous online questionnaire included queries about demographics, a condensed version of the Traumatic Life Events Questionnaire, and the MSDQ. Findings indicate strong internal consistency, reliability, incremental validity, and predictive validity of the instrument, indicating the superiority of the MSDQ's ability to predict sexual abuse compared to physical abuse or the loss of a family member. It is concluded that the MSDQ can be integrated into the evaluation process performed by healthcare professionals in the diagnosis of minors with unexplained symptomatology.

An Economic Evaluation of the Impact of Using Rapport-Based Interviewing Approaches With Child Sexual Abuse Suspects

Two studies examined whether rapport-based interviewing with child sexual abuse (CSA) suspects provides greater interview yield that could result in overall cost-savings to the investigation. First, multi-level modelling was applied to 35 naturalistic CSA suspect interviews to establish whether rapport-based interviewing techniques increase “yield” – defined as information of investigative value. The Observing Rapport Based Interviewing Technique (ORBIT coding manual was used to code interviews; it includes an assessment of both interpersonal adaptive and maladaptive rapport-based interviewer engagement as well as motivational interviewing (MI) strategies. The impact of these two strands (interpersonal and MI) on extracting information of investigative value (including strengthening a case for court and safeguarding) were examined. Adaptive interpersonal strategies increased case strengthening and safeguarding yield, with motivational interviewing having the largest impact on safeguarding yield. Both strategies increase the likelihood of gaining additional types of economic yield. Maladaptive interviewer strategies reduced case strengthening and different types of economic yield. In study two, literature-based economic estimates were applied to establish the potential cost benefits from following national ORBIT rapport training. Further training in adaptive and motivational interviewing could contribute cost savings between £19 and £78 million (annual unit costs) increasing to £238–£972 million (lifetime costs) for online CSA across England and Wales; and £157–£639 million (annual unit costs) increasing to £2–£8 billion (lifetime costs) for all CSA. Failure to commit training resource to this, or an alternative strategy, could mean the cost burden attributable to maladaptive interviewing (between £1 and £6 million for online CSA and £12 and £48 million for all CSA) is not successfully averted.

The dynamics of two-session interviews with suspected victims of abuse who are reluctant to make allegations

Supportive forensic interviews conducted in accordance with the National Institute of Child Health and Human Development Revised Protocol (RP) help many alleged victims describe abusive experiences. When children remain reluctant to make allegations, the RP guides interviewers to (a) focus on rapport building and nonsuggestive support in a first interview, and (b) plan a second interview to allow continued rapport building before exploring for possible abuse. We explored the dynamics of such two-session RP interviews. Of 204 children who remained reluctant in an initial interview, we focused on 104 who made allegations when re-interviewed a few days later. A structural equation model revealed that interviewer support during the first session predicted children's cooperation during the rapport-building phase of the second session, which, in turn, predicted more spontaneous allegations, which were associated with the interviewers' enhanced use of open-ended questions. Together, these factors mediated the effects of support on children's free recall of forensically important information. This highlighted the importance of emphasizing rapport with reluctant children, confirming that some children may need more time to build rapport even with supportive interviewers.

Can artificial intelligence achieve human-level performance? A pilot study of childhood sexual abuse detection in self-figure drawings

Childhood sexual abuse (CSA) is a worldwide phenomenon that has negative long-term consequences for the victims and their families, and inflicts a considerable economic toll on society. One of the main difficulties in treating CSA is victims' reluctance to disclose their abuse, and the failure of professionals to detect it when there is no forensic evidence (Bottoms et al., 2014; McElvaney, 2013). Estimated disclosure rates for child sexual abuse based on retrospective adult reports range from 23 % to 45 % (e.g., Bottoms et al., 2014). This study reports the four stages in the development of a Convolutional Neural Network (CNN) system designed to detect abuse in self-figure drawings: (1) A preliminary study to build a Gender CNN; (2) Expert-level performance evaluation, (3) validation of the CSA CNN, (4) testing of the CSA CNN model. The findings indicate that the Gender CNN achieved 88 % detection accuracy and outperformed the CSA CNN by 19 percentage points. The CSA CNN achieved 72 % accuracy on the test set with 80 % precision and 79 % recall for the abuse class prediction. However, human experts outperformed the CSA CNN by 16 percentage points, probably due to the complexity of the task. These preliminary results suggest that CNN, when further developed, can contribute to the detection of child sexual abuse.

A Response to "The Legacy of the Witch-Hunt Narrative"

The article provides an overview of and commentary on the last chapter of Cheit's book, The Witch-Hunt Narrative: Politics, Psychology and the Sexual Abuse of Children. The chapter is divided into two sections called "Recent Developments" and "The Legacy of the Witch-Hunt Narrative." We respond to the key assertions in each of those sections, providing discussion points of agreement and disagreement with Cheit, and note some areas Cheit does not cover, including important advances in the aftermath of the witch-hunt narrative (WHN). The article takes the position that there is cause for optimism with these advances in systems responses, child forensic interviewing research, and multidisciplinary team and training approaches; some of these advances are related to the WHN. The conclusion warns of the need to be vigilant about continuing Cheit's work, we suggest this could take place in six key areas: (a) enhanced teacher training, (b) improved court responses to child sexual abuse (CSA) victims, (c) expanded use of Extended Forensic Interviews so that the complex cases (children with disabilities, children from multi problem households) might be thoroughly considered for prosecution, (d) broadened focus on CSA validation, recovery, and prevention, (e) engaged multistate research on the actual occurrence of day care CSA allegations, and (f) expanded efforts to educate the public and potential jury pools about the nuances of CSA prosecution, and the illusion of toughness in how we respond to convicted offenders. Cheit's detailed research enables us to see where we came from, and what else needs to be done to understand the legacy of the WHN.

Impact of Repeated Questioning on Interviewers: Learning From a Forensic Interview Training Project

Forensic interviewers have a difficult job with high risk for career burnout and secondary trauma. Few studies have addressed how new forensic interviewers or trainees experience repeated questioning and multiple interviews. This study simulated the process of training new forensic interviewers through the creation of two interview videos in which social work graduate students participated as actors portraying the roles of interviewer and child. These films served as instructional aids preparing graduate social work students for professional child welfare roles while promoting research-based approaches to interviewing children about sexual abuse allegations. Qualitative data from two cohorts of student actors were collected to analyze interviewers' perspectives on repeated questioning and interviews in child sexual abuse cases. Two themes were extracted from the subjects' experiences: "It is emotionally taxing" and "Navigating the interviewer role is unexpectedly complex." Exposure to repeated questions and multiple interviews affected the performance and confidence of the interviewers.