Extended forensic evaluation when sexual abuse is suspected: a multisite field study

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.

Interviewing alleged victims with mild and moderate intellectual disabilities and autism: A field study of police-investigated cases of physical and sexual abuse in a Norwegian national sample

BACKGROUND

People with intellectual disabilities (IDs) or autism are at great risk of being victims of physical and sexual abuse. This study uses transcriptions of real-life investigative interviews to examine the interview techniques (e.g. question type) used in investigative interviews of these groups of alleged victims.

METHODS

A national sample of transcribed investigative interviews (N = 96) of alleged victims with mild ID (n = 48, age 5-70 years old), moderate ID (n = 18, age 14-43 years old) and autism (n = 16, age 5-50 years old) was analysed.

RESULTS

The study shows a preponderance of alleged sexual offences (70.7%) and reveals that open-ended questions account for only 2.6% of the total number of questions asked. The interviewers relied heavily on yes/no (53.4%) and directive questions (32.2%). Suggestive questions (8.6%) were frequently used.

CONCLUSIONS

The use of question type varied considerably within and across the diagnostic group. The study reveals the need for a more in-depth analysis of variables that influence investigative interviews of people with cognitive impairments.

The Cutting Edge of Forensic Interviewing

This article contextualizes new knowledge about forensically interviewing and assessing children when there are concerns about child abuse. The article references the impact of the Child Abuse Prevention and Treatment Act and the circumstance in the 1980s where investigators and clinicians had little guidance about how to interview children about alleged sexual abuse. It further speaks to the consequences of lack of interview guidelines and how videotaped interviews in the McMartin Pre-school cases served as the catalyst for the backlash against child interviewers and their interview techniques. Painful as the backlash was, it led to research and evidence-based practice in interviewing children about child sexual and other abuse. Principal among the practice innovations were forensic interview structures to be used when there is alleged child sexual and other abuse and the strong preference for one interview by a skilled interviewer, who is nevertheless a stranger to the child. Although these innovations satisfied many professionals in the child maltreatment field and critics of child interviewers, the new practices did not address a number of abiding issues: 1) how to meet the needs of children who are unable to disclose maltreatment in a single interview, 2) how to determine which children are suggestible in a forensic interview, and 3) how decisions are made about the likelihood of abuse, based upon the child's information during the interview. The articles in this special section address these cutting-edge issues.

Considerations for Pursuing Multiple Session Forensic Interviews in Child Sexual Abuse Investigations

Multiple session forensic interviews (MSFI) are a useful tool in the field of child sexual abuse forensic interviewing given the complexity of disclosures and the variety of child-centered needs observed in practice. This paper focuses on the Children's Advocacy Centers of Texas (CACTX) model for conducting MSFIs, illustrated by a description of the statewide training models offered to member centers and enumeration of the MSFI protocol guidelines implemented by one center. A brief history and review of the single session forensic interview (SSFI) is provided followed by considerations for MSFIs in order to establish the development of current and new practices. Clarification of terms are outlined with examples of cases to distinguish between multiple sessions and subsequent sessions. The MSFI guidelines presented demonstrate how an MSFI can fit with the SSFI model.

A meta-analysis of the prevalence of child sexual abuse disclosure in forensic settings

BACKGROUND

Identification, substantiation, prosecution, and treatment of child sexual abuse often rely heavily on a disclosure from the victim in the absence of corroborating evidence. For some, disclosure can be impeded by developmental or motivational barriers, thus compromising child safety and wellbeing. The literature on disclosure prevalence and mitigating influences does not yield a coherent picture. A more accurate estimate will help to inform investigation strategies to facilitate disclosure.

OBJECTIVE

This study provides a meta-analysis of available research examining the prevalence of sexual abuse disclosure in forensic interviews with children under 18 years, and examines a range of factors that may influence the likelihood of disclosure.

METHOD

Databases were searched for published and unpublished studies up to May 2017. In total, 2393 abstracts were assessed for eligibility, 216 full-text articles were reviewed, and 45 samples (with 31,225 participants) provided estimates of effect sizes.

RESULTS

The mean prevalence of child sexual abuse disclosure in forensic settings was 64.1% (95% CI: 60.0-68.1). Between-study variability was explained by: (1) child age and gender, with higher prevalence in older children and females; (2) prior disclosure, with higher prevalence when present; and (3) study year, with higher prevalence in more recent studies.

CONCLUSIONS

This meta-analysis confirms an upward trend in child sexual abuse disclosure prevalence. However, more than a third of children do not disclose when interviewed, with those who are younger, male, and without a prior disclosure at greatest risk. Important implications for forensic interviewing protocols and future research are discussed.

Recantation of Sexual Abuse Disclosure Among Child Victims: Accommodation Syndrome

BACKGROUND

Disclosing the sexual abuse may be related on many individual and/or environmental factors in all age groups. The sociocultural context is the most influential factor of the disclosing process especially for those living in patriarchal cultural values. This study compares the impacts of sexual abuse and other sociodemographic variables between recanting and non-recanting victimized groups in Adana city from Turkey.

METHODS

The samples attending our department were divided into two groups: group 1 comprised victims who recanted their first abuse disclosure, and group 2 comprised victims who insisted on the veracity of their first report at further evaluations. The characteristics of the child, family, and abuser were compared between recanting victims and non-recanting victims by retrospective data.

RESULTS

Each group included 27 children, for a total of 54 subjects. All adverse social reactions after the sexual abuse, including keeping secrets and a repressive family attitude, were higher among group 1 victims than group 2 victims (p < 0.0001).

CONCLUSIONS

Although they are victimized by protecting family integrity, victims may show a tendency to keep secrets and to not immediately disclose an abuse event.

Evidence for the Efficacy of the Child Advocacy Center Model: A Systematic Review

The Child Advocacy Center (CAC) model has been presented as the solution to many of the problems inherent in responses by authorities to child sexual abuse. The lack of referral to therapeutic services and support, procedurally flawed and potentially traumatic investigation practices, and conflict between the different statutory agencies involved are all thought to contribute to low conviction rates for abuse and poor outcomes for children. The CAC model aims to address these problems through a combination of multidisciplinary teams, joint investigations, and services, all provided in a single child friendly environment. Using a systematic search strategy, this research aimed to identify and review all studies that have evaluated the effectiveness of the approach as a whole, recognizing that a separate evidence base exists for parts of the approach (e.g., victim advocacy and therapeutic responses). The review found that while the criminal justice outcomes of the model have been well studied, there was a lack of research on the effect of the model on child and family outcomes. Although some modest outcomes were clear, the lack of empirical research, and overreliance on measuring program outputs, rather than outcomes, suggests that some clarification of the goals of the CAC model is needed.

Prosecutors' reflections on sexually abused preschoolers and their ability to stand trial

Child sexual abuse (CSA) cases are notoriously difficult to investigate, and less than 10% of cases are prosecuted. We aimed to investigate prosecutors' experiences of preparing for and prosecuting suspected CSA cases with preschool aged victims. Nine specialized child prosecutors (6 women, 3 men) took part either in individual interviews or in focus groups on this subject. The transcripts were analyzed thematically. The prosecutors said that children's testimony was sometimes held to an adult standard and that child complainants who expressed emotion could be perceived as more credible than their less expressive counterparts. CSA victims were identified as vulnerable victims who had difficulty telling their stories. Some of the interviewers were described as lacking in the ability to approach these children. The results imply that the reliability and credibility of sexually abused preschoolers and their testimony might be influenced by a number of verbal and non-verbal factors and that there are several obstacles preventing prosecutors from prosecuting these cases.

Support and reluctance in the pre-substantive phase of alleged child abuse victim investigative interviews: revised versus standard NICHD protocols

Children's unwillingness to report abuse places them at risk for re-victimization, and interviewers who do not respond sensitively to that unwillingness may increase the likelihood that victims will not disclose abuse. Interviewer support and children's reluctance were examined on a turn-by-turn basis using sequential analyses in 199 forensic interviews of 3- to 13-year-olds who alleged maltreatment. Half of the children were interviewed using the Revised Protocol that emphasized rapport-building (RP), the others using the Standard National Institute of Child Health and Human Development Protocol (SP). When using the RP, interviewers provided proportionally more support than when using the SP, but even when using the RP they did not specifically provide support when children expressed reluctance. The RP promoted immediate cooperation when reluctant utterances were met with support, however, suggesting that supportive statements were valuable. The findings enhance our understanding of children's willingness to participate in investigative interviews and the means through which interviewers can foster the comfort and well-being of young witnesses.

Witness recall across repeated interviews in a case of repeated abuse

In this illustrative case study we examine the three forensic interviews of a girl who experienced repeated sexual abuse from ages 7 to 11. She disclosed the abuse after watching a serialized television show that contained a storyline similar to her own experience. This triggered an investigation that ended in successful prosecution of the offender. Because this case involved abuse that was repeated on a weekly basis for 4 years we thus investigated the degree to which the child's narrative reflected specific episodes or generic accounts, and both the interviewer's and child's attempts to elicit and provide, respectively, specific details across the 3 interviews collected in a 1 month period. Across the 3 interviews, the child's account was largely generic, yet on a number of occasions she provided details specific to individual incidents (episodic leads) that could have been probed further. As predicted: earlier interviews were characterized more by episodic than generic prompts and the reverse was true for the third interview; the child often responded using the same style of language (episodic or generic) as the interviewer; and open questions yielded narrative information. We discuss the importance of adopting children's words to specify occurrences, and the potential benefits of permitting generic recall in investigative interviews on children's ability to provide episodic leads. Despite the fact that the testimony was characterized by generic information about what usually happened, rather than specific episodic details about individual occurrences, this case resulted in successful prosecution.

Is there a place for extended assessments in addressing child sexual abuse allegations? How sensitivity and specificity impact professional perspectives

Using data from a survey of perceptions of 932 child welfare professionals about the utility of extended assessments, the researchers constructed a scale to measure respondents' views about sensitivity (ensuring sexually abused children are correctly identified) and specificity (ensuring nonabused children are correctly identified) in child sexual abuse evaluations. On average, respondents scored high (valuing sensitivity) on the sensitivity versus specificity scale. Next, the researchers undertook bivariate analyses to identify independent variables significantly associated with the sensitivity versus specificity scale. Then those variables were entered into a multiple regression. Four independent variables were significantly related to higher sensitivity scores: encountering cases requiring extended assessments, valuing extended assessments among scarce resources, less concern about proving cases in court, and viewing the goal of extended assessments as understanding needs of child and family (adjusted R2 = .34).

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

In cases of suspected child sexual abuse (CSA) some professionals routinely recommend multiple interviews by the same interviewer because any additional details provided might improve decision-making and increase perpetrator convictions. We analyzed alternative policies about child interviewing to estimate the probability that a policy of all children receiving multiple interviews will increase criminal convictions and better protect children. Using decision analysis, we prepared a decision tree reflecting the structure through which a case of possible CSA passes through the health care, welfare, and legal systems with an estimated probability of conviction of the offender. We reviewed the CSA disclosure, criminal justice, and child welfare literature to obtain estimates for the median and range of rates for the steps of disclosure, substantiation, criminal charges, and conviction. Using the R statistical package, our decision analysis model was populated using literature-based estimates. Once the model was populated, we simulated the experiences of 1,000 cases at 250 sets of plausible parameter values representing different hypothetical communities. Multiple interviews increase the likelihood that an offender will be convicted by 6.1% in the average community. Simulations indicate that a policy in which all children seen for a CSA medical evaluation receive multiple interviews would cost an additional $100,000 for each additional conviction. We estimate that approximately 17 additional children would need to be interviewed on more than one occasion to yield one additional conviction. A policy of multiple interviews has implications for the children, for the costs of care, for protecting other children, and for the risk of false prosecution.

Extended evaluations in cases of child sexual abuse: how many sessions are sufficient?

This article provides new findings from a national study involving 18 forensic interview sites of 137 children who were randomly assigned to a four or eight session extended evaluation. Cases assigned to the eight session protocol were significantly more likely to be classified "credible disclosure" of sexual abuse (56.6%) than cases assigned to the four session protocol (29.5%) and significantly less likely to be classified "credible nondisclosure" of sexual abuse (9.2%) than cases in the four session protocol (24.6%). When four versus eight sessions, demographic variables, and case characteristics were entered into a regression, variables that predicted likelihood of sexual abuse were eight session protocol, older victim age, and caretaker belief the child had been sexually abused. When new disclosures were examined by session in the eight session protocol, 95% of new disclosures occurred by the sixth session.

The clinical-forensic dichotomy in sexual abuse evaluations: moving toward an integrative model

We propose the use of an approach to evaluation that can be undertaken in a clinical setting when concerns regarding child sexual abuse are unclear or ambiguous and other systems are not involved, thus providing an option for the nondisclosing child often discussed in the "delayed disclosure" literature. This approach can also be appropriate for a child with a questionable prior disclosure not being served by other intervention systems. We have labeled this an "integrative" model, incorporating forensically sound practices into evaluations conducted in a clinical setting. The goals of this manuscript are to (a) provide a rationale for conducting child sexual abuse extended evaluations in a clinical setting, (b) delineate the purposes of such evaluations, (c) differentiate this "integrative" model from the forensic-clinical dichotomy framework discussed by Kuehnle (1996), and (d) briefly describe the format, which can be refined by future practice and research.

Allegations of sexual abuse of a child: what to do when a single forensic interview isn't enough

This article describes the state of knowledge about extended assessments/forensic evaluations in situations of possible sexual abuse. It provides a critical review of the modest body of relevant research, describes two models for extended assessments, and presents descriptive survey findings of 62 professionals conducting extended assessments, most of whom conduct extended assessments intermittently as part of their other work on sexual abuse cases. Agencies should consider conducting extended assessments with young or traumatized children whose sexual abuse allegations are not resolved with a single interview as well as in complex child sexual abuse cases.

Human figure drawings and children's recall of touching

In 2 studies, children ages 3 to 7 years were asked to recall a series of touches that occurred during a previous staged event. The recall interview took place 1 week after the event in Study 1 and immediately after the event in Study 2. Each recall interview had 2 sections: In 1 section, children were given human figure drawings (HFDs) and were asked to show where the touching took place; in the other section, the same questions were asked without the HFDs (verbal condition). Children were randomly assigned to 2 different conditions: HFD 1st/verbal 2nd or verbal 1st/HFD 2nd. There were 2 major findings. First, HFDs elicited more errors than the verbal condition when used to probe for information that the child had already been asked. Second, regardless of interview method, children had poor recall of the touches even when these occurred minutes before the interview. It is suggested that cognitive mechanisms involving memory and semantics underlie children's poor recall of touching in both verbal and HFD conditions.

Exploratory assessments of child abuse: children's responses to interviewer's questions across multiple interview sessions

OBJECTIVE

The present study extends field research on interviews with young children suspected of having been abused by examining multiple assessment interviews designed to be inquisitory and exploratory, rather than formal evidential or forensic interviews.

METHODS

Sixty-six interviews with 24 children between the ages of 3 and 6 years who were undergoing an assessment for suspected child abuse were examined. Each child was interviewed 2, 3, or 4 times. The interviewer's questions were categorized in terms of openness (open, closed or choice), in terms of the degree of interviewer input (free recall, direct, leading, suggestive), and for topic (whether the question was abuse-specific or nonabuse-related). Children's on-task responses were coded for amount of information (number of clauses) reported in relation to each question type and topic, and off-task responses were categorized as either ignoring the question or a diverted response.

RESULTS

Children provided a response to most questions, independent of question type or topic and typically responded with one or two simple clauses. Some children disclosed abuse in response to open-ended questions; generally, however, failure to respond to a question was more likely for abuse-specific than for nonabuse-related questions.

CONCLUSION

The findings are discussed in terms of the growing literature on interviewing children about suspected abuse, particularly in interviews conducted over multiple sessions.

PRACTICE IMPLICATIONS

Assessment of suspected child abuse may involve more than a single investigative interview. Research examining children's responses to questioning over multiple interviews (or single interviews conducted over multiple sessions) is necessary for the development of best practise guidelines for the assessment of abuse.

Child forensic interviewing in Children's Advocacy Centers: empirical data on a practice model

OBJECTIVE

Children's Advocacy Centers (CACs) aim to improve child forensic interviewing following allegations of child abuse by coordinating multiple investigations, providing child-friendly interviewing locations, and limiting redundant interviewing. This analysis presents one of the first rigorous evaluations of CACs' implementation of these methods.

METHODS

This analysis is part of a quasi-experimental study, the Multi-Site Evaluation of Children's Advocacy Centers, which evaluated four CACs relative to within-state non-CAC comparison communities. Case abstractors collected data on investigation methods in 1,069 child sexual abuse cases with forensic interviews by reviewing case records from multiple agencies.

RESULTS

CAC cases were more likely than comparison cases to feature police involvement in CPS cases (41% vs. 15%), multidisciplinary team (MDT) interviews (28% vs. 6%), case reviews (56% vs. 7%), joint police/child protective services (CPS) investigations (81% vs. 52%) and video/audiotaping of interviews (52% vs. 17%, all these comparisons p<.001). CACs varied in which coordination methods they used, and some comparison communities also used certain coordination methods more than the CAC with which they were paired. Eighty-five percent of CAC interviews took place in child-friendly CAC facilities, while notable proportions of comparison interviews took place at CPS offices (22%), police facilities (18%), home (16%), or school (19%). Ninety-five percent of children had no more than two forensic interviews, and CAC and comparison differences on number of interviews were mostly non-significant.

CONCLUSIONS

Relative to the comparison communities, these CACs appear to have increased coordination on investigations and child forensic interviewing. The CAC setting was the location for the vast majority of CAC child interviews, while comparison communities often used settings that many consider undesirable. CACs showed no advantage on reducing the number of forensic interviews, which was consistently small across the sample.

Exploring the disclosure of child sexual abuse with alleged victims and their parents

OBJECTIVE

The goal of the present study was to examine how children disclosed sexual abuse by alleged perpetrators who were not family members.

METHODOLOGY

Thirty alleged victims of sexual abuse and their parents were interviewed. The children were interviewed using the NICHD Investigative Interview Protocol by six experienced youth investigators. The same principles were followed when the parents were asked to describe in detail what had happened since the abusive incidents. The statements made by the children and parents were then content analyzed. Major characteristics of the children's and parents' reported behaviors were identified by two independent raters.

FINDINGS

More than half (53%) of the children delayed disclosure for between 1 week and 2 years, fewer than half first disclosed to their parents, and over 40% did not disclose spontaneously but did so only after they were prompted; 50% of the children reported feeling afraid or ashamed of their parents' responses, and their parents indeed tended to blame the children or act angrily. The disclosure process varied depending on the children's ages, the severity and frequency of abuse, the parents' expected reactions, the suspects' identities, and the strategies they had used to foster secrecy.

CONCLUSIONS

The children's willingness to disclose abuse to their parents promptly and spontaneously decreased when they expected negative reactions, especially when the abuse was more serious. A strong correlation between predicted and actual parental reactions suggested that the children anticipated their parents' likely reactions very well.

"A burden in your heart": lessons of disclosure from female preadolescent and adolescent survivors of sexual abuse

OBJECTIVES

To enhance understanding of the sexual abuse disclosure process from the perspective of preteen and teenage survivors. To reconsider prominent models of the disclosure process in light of our findings.

METHODS

We conducted a secondary analysis of data from four focus groups in which 34 preadolescent and adolescent female survivors of sexual abuse had been asked about their treatment experiences. Girls often recounted disclosing their victimization to others. Using the disclosure segment as our unit of analysis, we isolated 106 for study. During analysis, we wrote narrative summaries of each segment's significance, grouped these conceptually, and examined their interconnectedness. When synthesized, individual experiences of disclosing contributed to understanding the overall disclosure process.

RESULTS

Three phases were identified: Self, where children come to understand victimization internally; Confidant Selection-Reaction, where they select a time, place, and person to tell and then weather that person's reaction (supportive or hostile); and Consequences (good and bad) that continued to inform their on-going strategies of telling. The actions and reactions of adults were significant and informed the girls' decisions.

CONCLUSIONS

We advocate integrating existing theories and research into a model which views the disclosure process from the child's perspective and includes pre-disclosure and a post-initial public disclosure stages. The model conceptualizes disclosure as an iterative process in which children interact with adults and incorporate responses into their on-going decisions about telling (recant, deny, affirm, etc.). The combined model should recognize the concerns and position of adults as well as the perspective and logic of youth.

Improving decision making in forensic child sexual abuse evaluations

Mental health professionals can assist legal decision makers in cases of allegations of child sexual abuse by collecting data using forensic interviews, psychological testing, and record reviews, and by summarizing relevant findings from social science research. Significant controversy surrounds another key task performed by mental health professionals in most child sexual abuse evaluations, i.e., deciding whether or not to substantiate unconfirmed abuse allegations. The available evidence indicates that, on the whole, these substantiation decisions currently lack adequate psychometric reliability and validity: an analysis of empirical research findings leads to the conclusion that at least 24% of all of these decisions are either false positive or false negative errors. Surprisingly, a reanalysis of existing research also indicates that it may be possible to develop reliable, objective procedures to improve the consistency and quality of decision making in this domain. A preliminary, empirically-grounded procedure for making substantiation decisions is proposed.

Expectations test: trauma scales for sexual abuse, physical abuse, exposure to family violence, and posttraumatic stress

Gully's 2000 Expectations Test was developed as a tool to use with children ages 4 through 17 to measure social information processing. Prior research suggested it could help identify abused and emotionally traumatized children. Results from regression analyses were used to develop four scales that could be calculated simply. Prior research demonstrated excellent interrater reliability for the variables from the Expectations Test used in the regression analyses. The minimum Cronbach's alpha for any scale is .75. The minimum test-retest reliability is .88. Classification results indicated each scale can provide data to help evaluate children: Sexual Abuse Scale (sensitivity = 81% and specificity = 78%), Physical Abuse Scale (84% and 78%), Exposure to Family Violence Scale (65% and 63%), and Posttraumatic Stress Scale (86% and 54%). However, careful attention needs to be given to the potential limitations of these scales to prevent their misuse.