Adult Disclosure of Child Sexual Abuse: A Literature Review

"Mend the rift" therapeutic model for working with sibling sexual abuse: Professionals' perspectives

BACKGROUND

Sibling sexual abuse (SSA) is considered the most prevalent and longest-lasting type of interfamilial sexual abuse. The psychological implications of SSA may be felt throughout the harmed siblings' lifespan. Nevertheless, SSA receives very little therapeutic attention.

OBJECTIVE

The present study explores how professionals dealing with the phenomenon see how to work with such cases.

PARTICIPANTS AND SETTING

Fifty-two professionals working in the field of SSA participated in the study and completed closed and open-ended questionnaires.

METHODS

A mixed-method research approach was implemented to quantitatively and qualitatively analyze the professionals' responses.

RESULTS

The findings addressed three main intervention aspects. The first comprised the key unique therapeutic themes of SSA interventions that differentiate the SSA therapeutic process from other child sexual abuse cases. These included complex familial dynamics (e.g., secrecy climate, loyalty conflict, and intergenerational transmission of trauma) and at-home risk. The second addressed the therapeutic goals, including rebuilding family relationships and promoting safety strategies at home. The third was the SSA intervention structure, defining the structural elements of a holistic therapeutic model for family care.

CONCLUSIONS

Based on the findings, a therapeutic model for family intervention in SSA cases was proposed, aiming to define service characteristics, determine who should be involved in the therapeutic process, and identify who should lead the intervention. The research contributes to the advancement of the theoretical and practical knowledge necessary to address the inherent familial complexities in SSA cases and the enhancement of the therapeutic orientation for professionals involved in such cases.

"I Cannot Tell Anyone:" There are Many Reasons

Purpose: The purpose of this study was to investigate variables associated with difficulty disclosing past trauma. Across several prevalence studies, 26% of adults never disclosed childhood abuse until adulthood when they were asked in a research survey or interview question. In this Institutional Review Board approved study, group differences were examined (ability and inability to disclose a traumatic event) as well as predictors for difficulty disclosing past trauma. Method: A non-clinical population (N = 693) was examined to determine prevalence rates and group differences between participants unable to tell someone about a past traumatic event (10%) compared to those who could disclose past traumatic events (90%). Variables included pathological dissociative processing, internalized shame, coping strategies (task, emotion, avoidance), and cumulative trauma exposure. Logistic regression analyses were conducted to determine predicting variables for disclosure difficulties. Findings: The group that had difficulty disclosing a past traumatic event had more cumulative trauma, pathological dissociative processing, emotion-oriented coping, and shame. In the first logistic regression analyses, interpersonal traumatic events were predictors for the inability to disclose a traumatic event (classified 90% of group membership). In the second logistic regression, shame and cumulative traumatic exposure were predicting factors (classified 90% of group membership). Conclusion: Difficulty speaking about a traumatic event was associated with interpersonal adult and childhood traumatic events, more internalized shame, and cumulative trauma exposure. It is recommended that clinicians working with patients with substantial traumatic exposure address shame, pathological dissociative processing, and emotion-oriented coping strategies if they detect trauma disclosure difficulties.

The Process of Online Disclosures of Interpersonal Victimization: A Systematic Review

Theory and research on disclosure of interpersonal victimization, including intimate partner violence, sexual assault, and child abuse, has produced rich scholarship promoting a greater understanding of the challenges and implications of disclosure for survivors. However, in the last decade, social media platforms have opened new online disclosure opportunities that diverge from and overlap with offline disclosure. This highlights the need for adaptation and elaboration of theorizing in this growing area of study. Thus, the study aimed to systematically review the studies published in scientific literature. The following databases were accessed Criminal Justice Abstracts, Medline PsychInfo, Social Work Abstracts, Sociological Abstracts, Web of Science database, and Google Scholar. Twenty-seven studies met the inclusion criteria of peer-reviewed status and focused on the disclosure process. A thematic analysis revealed that online disclosure of interpersonal victimization is a multi-phase (decision-making and disclosure aftermath) and multifactorial (individual, interpersonal, social, and technological) experience for survivors. Specifically, survivors' motivation was related to therapeutic goals, social support, and a desire to advocate for social change. Survivors faced numerous facilitators (e.g., inspiration from other online disclosures) and barriers (e.g., fear of triggering other survivors) to disclosure. The impact of online disclosure was divided into benefits (e.g., empowerment) and risks (e.g., undermining survivors' security). The conceptual and empirical limitations of the current research are discussed, including a need for quantitative methods with larger samples and longitudinal designs to better understand how survivors can best benefit from processes of online disclosure, while avoiding harm or re-traumatization.

Athletic identity affects prevalence and disclosure of emotional abuse in Finnish athletes

The present study offers novel insight into the topic of experienced and observed emotional abuse by researching factors that affect athletes' responses to emotional abuse by coaches. The research aimed to explore three main questions: (1) whether athletic identity was associated with the prevalence of emotionally abusive coaching practices, and (2) disclosure of emotional abuse, and (3) whether demographic variations existed in the frequency of emotional abuse, athletic identity, and disclosure of the abuse. Study participants who filled in an anonymous digital survey consisted of athletes from elite to leisure levels living in Finland (N = 3687, aged 12-80, gender 61% female, 37.7% male, 0.8% other genders). The research findings highlighted three key insights. Firstly, Pearson correlations revealed that a salient athletic identity was related to a higher prevalence of emotional abuse. Secondly, ANOVA/Kruskal-Wallis tests between-groups indicated that particularly children were susceptible to the abuse. Thirdly, a mediation analysis showed that self-identity (aspect of athletic identity) influenced the relationship between experienced emotional abuse and disclosure, by reducing disclosure. As a result, holistic identity development is recommended for athletes and particularly children in sports.

"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.

Nonconsensual Sexual Experience Histories of Incarcerated Men: A Mixed Methods Approach

Nonconsensual sexual experiences (NSEs) may contribute to mental health concerns among incarcerated individuals, yet NSEs are understudied in this population. This study takes a novel approach in examining the prevalence of NSEs among incarcerated males by utilizing both quantitative and qualitative measures. The sample consisted of 189 men from three provincial maximum-security prisons in Ontario, Canada. Based on quantitative findings, 44.2% of the sample experienced NSEs before the age of 18, and 41.7% of the sample endorsed an experience that fit the legal definition of a NSEs as adults. Participants also responded to a qualitative open-ended question about their history of NSEs. Based on qualitative findings, a total of 23% of the men reported at least one incident of a NSE (e.g., child and adult). Based Findings highlight the high prevalence of NSEs among incarcerated men with quantitative responses demonstrating how the use of a behavioral questionnaire may, to some extent, correct for underreporting of NSEs. Qualitative responses illustrate the lived experience of incarcerated men and provide a deeper understanding of their NSEs. Responses also speak to the lack of resources and support available to these men. Findings underscore the need for proactive approaches in meeting mental health needs of incarcerated men in general and with regard to NSEs in particular. Results may inform the development of future correctional procedures (i.e., intake protocols that account for men with NSEs) and resources to support incarcerated men in navigating the psychological impact of non-consensual sexual experiences.

Aspects of Selective Sexual Assault Disclosure: Qualitative Interviews With Survivors and Their Informal Supports

Two-thirds of survivors typically disclose their experience to informal supports (e.g., friends, family, partners) at some point following sexual assault, but little in-depth research has addressed specific aspects of disclosure. In the current study, a diverse sample of 45 sexual assault survivors and their informal support providers (SP; e.g., family, friends, romantic partners) were interviewed separately about experiences of disclosure, social reactions, and help-seeking following the assault. Narrative data on the overarching thematic category of selective disclosure were analyzed using thematic analysis methods. Several subthemes emerged specific to (a) the circumstances of disclosure (prompted or coerced), (b) withholding details (framing disclosures to avoid rape myths and blame, strategic use of language, protecting others by not disclosing or limiting details), and (c) sharing details (selecting who was told, selecting trusted others for disclosure, selective details told to specific people, sharing with strangers easier). Implications are drawn for future research on aspects of selective disclosure of sexual assault and clinical practice implications for supporting survivors and their informal support networks.

A systematic review of factors associated with disclosure of child sexual abuse

BACKGROUND AND OBJECTIVE

Disclosure of CSA is key to victims having access to support and protection, but the current understanding of what factors play a key role is still limited. The present review aims to understand a range of socio-ecological factors that can either facilitate or obstruct the disclosure of CSA.

METHODS AND RESULTS

Through a systematic review of 27 quantitative studies published from 2000 to 2022, the current review identified 17 significant predictors of CSA disclosure. Facilitators of disclosure included older age, being female, higher IQ, recent abuse, resistance during abuse, clergy perpetrator, non-offending caregiver support, and acculturation. Barriers to disclosure included intellectual disability, avoidant coping, romantic relationships with the perpetrator, family criminality, domestic violence, adherence to traditional Asian values, and ethnic minority identity. The findings also suggested that the relationship between predictors and disclosure tends to be mixed, contradictory, or indirect/interactional, emphasizing the importance of situating the findings in specific social-ecological contexts.

CONCLUSIONS

The findings can inform future research and practice by providing a comprehensive understanding of the predictors of CSA disclosure and highlighting the importance of considering the socio-ecological context when interpreting findings. Moreover, the review provides a valuable resource for professionals who work with victims of CSA, helping them better identify factors that may facilitate or hinder disclosure and allowing for tailored interventions.

Psychologist attitudes towards disclosure and believability of childhood sexual abuse: Can biases affect perception, judgement, and action?

BACKGROUND

The perception of CSA disclosure belief is critical to long-term outcomes for CSA survivors. Despite disclosures often occurring in clinical settings CSA survivors do not always report a sense of clinician belief in response to their disclosure. Ascertaining the factors that influence clinician belief is essential to improving outcomes.

OBJECTIVE

This study examined whether language (i.e., word choice to describe abuse) and ongoing relationship status with a perpetrator impact perceptions of CSA belief amongst psychologists.

METHODS

This 2 × 2 within subject's study examined relationship effects (ongoing verses estranged) and language effects (consensual verses abusive), embedded in fictitious vignettes, on believability. Seventy-five participants completed demographic surveys, rated and discussed belief in four vignettes, and completed validated scales capturing clinician trauma history and CSA myth endorsement.

RESULTS

A significant main effect for relationship was found with ongoing victim-perpetrator relationships being less believed than depictions of estranged relationships (F(1,3) = 15.57, p = .001, h2 = 0.174). While no main effect for language was found (F(1,3) = 0.06, p = .801, h2 = 0.001) content analysis of the open-ended items revealed 80 % of psychologists reported being influenced by the language manipulations. Correlations revealed male psychologists were less likely to believe disclosures and more likely to endorse CSA myths than females, and psychologists who had engaged in trauma training appeared to have heightened disclosure belief and lower myth endorsement.

CONCLUSIONS

While psychologists generally report belief in CSA disclosures they appear to evaluate specific disclosure aspects to inform this level of belief. Issues around social desirability, measure sensitivity, and learning effects are discussed alongside the importance of trauma training for psychologists.

Sexual Violence Disclosure in #Notokay: Disclosure Goals, Disclosure-Facilitating Resources, and Overall Disclosure Trajectory

This study investigated the disclosure goals, disclosure-facilitating resources, and overall disclosure trajectory of 16 women who participated in the 2016 #notokay antisexual violence campaign. Findings indicate that most participants' disclosure goals were approach focused. Factors that facilitated disclosure were social media affordances and psychological, professional, and financial resources. Participants' overall disclosure trajectory was upward, but not linear, and disclosure outcomes included self-growth and awareness of the intersectional nature of violence. The findings suggest that the disclosure processes model can be strengthened by considering goal-relevant resources as a structural or environmental factor that influences the choice of approach versus avoidance goals, and consequently, beneficial or harmful disclosure outcomes. Further, by investigating how participants' #notokay disclosure was situated in their other online and offline disclosure episodes, this study provides a contextualized perspective of online hashtagged disclosures of sexual violence.

"I Never Said Anything. I Didn't Tell Anyone. What Would I Tell?" Adults' Perspectives on Disclosing Childhood Sibling Sexual Behavior and Abuse in the Orthodox Jewish Communities

Sibling sexual harmful dynamics (SSHD) is a term used, in this study, to refer to childhood sexual behaviors that are inconsistent with age-appropriate curiosity, including sibling sexual abuse (SSA). Although SSA is a prevalent and long-lasting form of intrafamilial sexual abuse, it is the least reported, studied, and treated. This study aims to deepen the understanding of the disclosure process of this phenomenon in the Israeli Orthodox Jewish society, as perceived by those involved. Participants were adults from the Orthodox communities in Israel who experienced sexual interactions/abuse with one or more of their siblings. This qualitative constructivist-grounded theory study was based on semi-structured interviews with 24 adults from the Israeli Orthodox Jewish communities. Seven barriers to disclosure were identified and organized into three main categories: intrapersonal, including denial of the acts, guilt, and shame; interpersonal, including the sibling relationship and perceiving the sexual acts as routine; and cultural, including lack of sexual knowledge, the concept of modesty, and marriage prospects. In addition, we highlight the intersectionality between the different contexts of the SSHD. This study explored the barriers to disclosing SSHD in the siblings' context and the context of the Jewish Orthodox communities. The findings contribute to understanding the unique aspects of the disclosure, as expressed in religious and cultural contexts, the sibling context, and their intersectionality. Cultural and religious sensitivity is crucial for practitioners, especially as issues of sexuality and sexual understanding stem from the related norms and values.

"One Day It Will Be Over, and You Will See Other Landscapes. . . You Are Not Alone": Adult Survivors' Messages to Children Undergoing Child Sexual Abuse

Child sexual abuse (CSA) has received considerable attention from scholars, contributing to policy, intervention, and prevention efforts worldwide. However, survivors' involvement in this research is limited. This study was designed to delve into the messages of adult CSA survivors to abused children. In all, 371 written testimonies were provided to the Israeli Independent Public Inquiry on CSA by survivors from diverse communities in Israel. The Inquiry aimed to promote change in policies related to CSA. The testimonies were analyzed using the qualitative thematic analysis method. The results revealed five main messages emphasized by survivors to children experiencing CSA: (a) transferring the responsibility and guilt from children to perpetrators and society; (b) turning toward the light and continuing on; (c) disclosure is essential; (d) a happy life is possible; and (e) together we can survive. The discussion emphasizes how various systems in survivors' lives have profound impacts following the abuse. Although survivors were from diverse backgrounds, their messages to abused children were consistent. Through their messages to the children, the survivors emphasized their wish to transfer responsibility and guilt from children experiencing abuse to the society that is supposed to see, listen, protect, and validate. Implications for practice are discussed, focusing on the importance of making room for survivors' voices and experiences in the processes of shaping policies in the area of CSA. Moreover, the survivors' desire to be there for the children emphasized the urgent need to promote the perception of survivors as key stakeholders in the field of child abuse and to integrate their experiences and perceptions into the formal and informal systems for children.

Associations among posttraumatic growth, demographic characteristics, posttraumatic stress symptoms, and trauma type, with a focus on sexual violence

This study assessed posttraumatic growth (PTG) across multiple trauma types and by demographic characteristics (i.e., sex, age, education). Moreover, we examined the association between PTG and posttraumatic stress disorder (PTSD) symptoms as well as the characteristics and predictors of PTG after sexual violence. A phone survey was conducted in a nationally representative sample of 1,766 Icelandic adults. In total, 1,528 individuals reported having experienced some form of trauma and were included in the analysis, and 563 reported experiencing sexual violence. Interpersonal trauma (e.g., sexual violence, emotional abuse, and domestic violence) was associated with the highest levels of PTG. Moderate levels of PTSD symptoms were associated with the highest levels of PTG, whereas high- or low-level PTSD symptoms were related to less PTG. Women reported significantly more PTG than men, d = 0.16 and survivors of sexual violence reported significantly more PTG than individuals who reported other forms of trauma exposure, d = 0.28. Among sexual violence survivors, no demographic factors were associated with PTG, but cumulative trauma and positive social reactions were significantly related to higher levels of PTG. This study highlights that personal growth can result from aversive experiences and suggests a curvilinear association between PTG and PTSD symptoms.

Development and Validation of the Disclosure Expectancy Scale

Although the disclosure of traumatic experiences is believed to influence trajectories of post-trauma recovery, less is known about individual differences that affect survivors' motivation to share. The current project describes the development and evaluation of the Disclosure Expectancy Scale (DExS), a novel instrument intended to assess survivors' expectations about the potential risks and benefits of disclosure. Items targeting both positive and negative expectancies were generated based on existing research and the authors' clinical experience with various survivor populations. Preliminary analyses in trauma-exposed undergraduates (N = 359) offer support for hypothesized positive and negative expectancy dimensions with evidence for the convergent and discriminant validity of scores. Subsequent evaluation in active-duty, help-seeking military personnel (N = 35) provides further evidence of validity based on correlations with relevant clinical measures. A final regression demonstrating unique effects of initial disclosure expectancies on post-traumatic stress disorder (PTSD) severity following trauma-focused treatment highlights the predictive validity of DExS scores.

The embodiment of childhood abuse and anorexia nervosa: A body mapping study

Childhood trauma has long been implicated in the development of anorexia nervosa and is known to impact more women than men. Still, less is known about the meaning women attribute to food and bodily practices and how they contribute to feminine subjectivity. In this article, we examine the subjective experiences of women with histories of childhood abuse and anorexia and women who did not develop an eating disorder. Through a visual narrative analysis of eight body maps and narratives, we identified five themes: "time and the body have a way of showing what matters," "femininity and family," "sexual subjectivities and food meanings," "voices, dissociation, and sexual subjectivities," and "religion and healthism." In women with anorexia, specific eating and bodily practices reconstructed the traumatic events to align with the available cultural discourses related to health, religion, and family and had implications for their feminine and sexual subjectivities and self-worth. This research showcased how arts-based methodologies add value and advance knowledge about the role of culturally available representations in the development of anorexia and has implications for therapy and prevention of anorexia.

Understanding healthcare services response to technology - assisted child sexual abuse: A freedom of information study

BACKGROUND

The reported rates of technology-assisted child sexual abuse (TA-CSA) have increased in the last decade. It is unclear how services are currently responding to cases of child sexual abuse that involve an online element.

OBJECTIVE

The aim of this study is to understand the current framework of support offered by National Health Service (NHS) UK Child and Adolescent Mental Health Services (CAMHS) and Sexual Assault Referral Centres (SARC) for cases involving TA-CSA. This includes understanding if a services' current assessment tools refer to TA-CSA, whether interventions address TA-CSA, and assessing what training for TA-CSA is offered to practitioners.

SETTING

Sixty-eight NHS Trusts with either an affiliated CAMHS or SARC.

METHOD

A Freedom of Information Act request was sent to NHS Trusts. Under this Act, the Trust had 20 working days to respond to the request, which included 6 questions.

RESULTS

86 % Trusts (42 CAMHS and 11 SARC) responded to the request. Of the responses, 54 % CAMHS and 55 % SARC offer relevant training to practitioners. 59 % CAMHS and 28 % SARC provide tools for their initial assessment that reference online life. No Trust provided a clear treatment approach for TA-CSA, with 35 % CAMHS and 36 % SARC responding that treatment would address the mental health needs of the young person.

CONCLUSIONS

There is a need for a nationwide understanding of how to clearly define TA-CSA in policies and how to approach TA-CSA during an initial assessment. Further, a consistent approach on how to equip practitioners with tools to support individuals who have experienced TA-CSA is urgently needed.

Facilitators of Sexual Assault Disclosure: A Dyadic Study of Female Survivors and Their Informal Supports

Two-thirds of survivors typically disclose their experience to others at some point following sexual assault, but little in-depth research has addressed factors facilitating disclosure. In the current study, a diverse sample of 45 female sexual assault survivors (75% racial/ethnic minorities) and their 45 informal support providers (SP; e.g., family, friends, romantic partners) were interviewed separately about experiences of disclosure, social reactions, and help-seeking following assault. Disclosure facilitation was expressed by 40 survivors and 31 SPs, of which 28 were matched S/SP dyadic pairs. Narrative data on the overarching thematic category of sexual assault disclosure facilitation was analyzed using descriptive thematic analysis methods. Several themes emerged from the analysis of quotes specific to the facilitation of disclosure, including: individual (e.g., survivor psychological, behavioral, and disclosure recipient factors), interpersonal (e.g., SP-solicited disclosures, helping others, mutual disclosures), and societal (e.g., lack of barriers, formal supports, media). Implications are drawn for future research on facilitators of sexual assault disclosure. Clinical practice implications are provided for professionals supporting survivors and their informal support networks.

The stronger and the weaker sex - gender differences in the perception of individuals who experienced physical and sexual violence in childhood. A scoping review

BACKGROUND

Violence against children is an issue of serious concern. Stigma impacts coping with childhood trauma. A central aspect regarding disclosing trauma and seeking help is the social perception of the victim and survivor's gender.

OBJECTIVE

This review aims to synthesize qualitative and quantitative research about the impact of the victim and survivor gender on the societal perceptions of individuals who have experienced sexual and/or physical violence in childhood.

PARTICIPANTS AND SETTING

This review considered both society's and victims and survivors' perspectives on gender-linked perceptions concerning individuals with childhood trauma.

METHODS

The initial search was conducted in November 2021 and involved the databases Web of Science, PubMed, and PsychInfo. All studies, published in English or German, that reported study design, sample characteristics, and gender-linked perceptions of individuals with a history of sexual and/or physical violence in childhood were included.

RESULTS

A total of 10,373 studies were identified, of which 20 studies were eligible for review. Six studies reported no significant victim gender effect. However, when significant victim gender effects were present, males were characterized with considerably more stigmatizing attributes regarding the blame category while females were exposed to considerably more stigmatizing attributes regarding the harm category.

CONCLUSIONS

Females and males experience stigmatization reflecting typical stereotypes of femininity and masculinity. Thus, females are perceived as more vulnerable, more burdened, and with a higher need for security than males. Males are seen as more blameworthy and less trustworthy than females due to their presumed capability to physically resist or escape abuse.

Does Forgiveness Enhance Or Detract From Relationship Quality Among Sexual Abuse Survivors?

Many women experience childhood sexual abuse (CSA) during their childhood and CSA often negatively impacts adult's romantic relationships. Consequently, it is important to understand the protective factors that buffer against the detrimental impact of CSA on the quality of women's romantic relationships. Forgiveness may be one such factor. The current study looked at trait forgiveness as a moderator of CSA and overall relationship quality, positive relationship quality, and negative relationship quality. A sample of 171 women completed an online survey. Using hierarchical regression, forgiveness was found to moderate the association between CSA and overall relationship quality and negative relationship quality, but not positive relationship quality. Findings indicate that the interaction between CSA and forgiveness was significant, but higher levels of forgiveness actually decreased overall relationship quality and increased negative relationship quality. The relationship between CSA and overall reports of relationship quality and negative relationship quality were stable at low levels of forgiveness, but when forgiveness was high overall relationship quality decreased and negative relationship quality increased. CSA was also directly associated with lower levels of positive relationship quality. Findings from the study indicate continued conceptual refinement when considering CSA, forgiveness, and relationship quality.

Recovering the Lost Soul: Older Women's Reflections on Past Intrafamilial Child Sexual Abuse

Intrafamilial child sexual abuse (IFCSA) is a social problem with longstanding effects on victims' lives. While scholarly literature has focused on the adverse aftermath of sexual abuse, only a few studies have acknowledged older women's perspectives on their experience of IFCSA and their journey of healing and recovery. The aim of the present study was to explore how older survivors of IFCSA construct and shape their experience of healing in later life and the meaning they assign to this process. Narrative inquiry was selected to explore the narratives of 11 older women survivors of IFCSA. Participants were interviewed using a biographical narrative interviewing method. The narratives were then transcribed and analyzed using thematic, structural, and performance analyses. Four major themes emerged from the participants' narratives: Achieving closure; Spiritual framing of IFCSA as a platform for self-growth; Becoming whole in old age; and Looking to the future after IFCSA. During the aging years, IFCSA survivors may redefine their identity and their place in the world. Using life review processes, older women in this study were striving to heal and reconcile with their past.

Searching for secrets, searching for self: Childhood adversity, self-concept clarity, and the motivation to uncover family secrets through direct-to-consumer genetic testing

Direct-to-consumer (DTC) genetic tests have become an attractive product for those hoping to gain insight into their health, ancestry, and biological relatedness. In some cases, test results are unexpected, and lead to the revelation of previously undisclosed family secrets. A subset of individuals may pursue testing explicitly for this purpose; however, the psychosocial processes underlying this motivation remain unexamined. Grounded in the literature on family secrecy, trauma, and the development of self-concept, we tested a hypothesized mediation model to provide insight into this motivation among a sample of 433 individuals in pursuit of DTC genetic testing. In line with the documented association between maladaptive family communication patterns and trauma exposure in childhood, we found that exposure to adverse childhood experiences was associated with the motivation to pursue DTC genetic testing for the purpose of uncovering family secrets. We also found evidence of an indirect effect through reduced self-concept clarity. These findings suggest that impaired identity formation processes may have played a role in transmitting the effect. Furthermore, the findings highlight a novel way in which family histories may contribute to DTC genetic testing motivations. Future examination of these and other psychosocial phenomena that contribute to DTC genetic testing will be crucial to consider as the tests become increasingly accessible, and as the information they can provide becomes increasingly comprehensive. Findings from this line of research could help to identify for whom and under what conditions DTC genetic testing benefits well-being, and the conditions under which the act of testing and receipt of results could have adverse psychosocial effects. These insights will be of interest to genetic counselors working in the field of DTC genetic testing, and those working with individuals and families affected by unexpected test results.

Old crimes reported in new bottles: the disclosure of child sexual abuse on Twitter through the case #MeTooInceste

Movements such as #MeToo have shown how an online trend can become the vehicle for collectively sharing personal experiences of sexual victimisation that often remains unreported to the criminal justice system. These social media trends offer new opportunities to social scientists who investigate complex phenomena that, despite existing since time immemorial, are still taboo and difficult to access. They also bring technical difficulties, as the challenge to identify reports of victimisation, and new questions about the characteristic of the events, the role that victimisation testimonies play and the capacity to detect them by analysing their characteristics. To address these issues, we collected 91,501 tweets under the hashtag #MeTooInceste, posted from the 20 to 27 January 2021. A model was fitted using Latent Dirichlet Allocation that detected 1688 tweets disclosing experiences of child sexual abuse, with an accuracy of 91.3% [± 3%] and a recall of 93.1% [± 5%]. We performed Conjunctive Analysis of Case Configurations on the tweets identified as disclosures of victimisation and found that long tweets posted by users with small accounts, without URL or picture, were more likely to be related to disclosure of child sexual abuse. We discuss the possibilities of these trends and techniques offer for research and practice.

Self-Reported Experience of Abuse During the Life Course Among Men Seeking General Psychiatric or Addiction Care-A Prevalence Study in a Swedish Context

A prevalence study was conducted using the NorVold Abuse Questionnaire for men (m-NorAQ) to estimate the prevalence of self-reported experience of life-course abuse and to identify the perpetrators of the abuse. This among men seeking general psychiatric and addiction care in a Swedish context. In total, 210 men completed the questionnaire, and were included in the study. The total prevalence of life-course abuse (i.e., any emotional, physical or sexual abuse during the life course) was 75% (n = 157). The results of this study indicate the importance of identifying experiences of life-course abuse among men in general psychiatric and addiction care settings.

The Impact of Critical Life Points and Events for Survivors of Institutional Child Sexual Abuse: Understanding Trauma and the Role of Compensation in Recovery

Although the impact of child sexual abuse (CSA) is well documented in the international literature, little is known about the critical points of recovery across the life course for survivors of institutional CSA. The aim of this study was to identify critical points, or events across the life course that may increase, or decrease, a survivor's vulnerability to the complex traumatization of institutional CSA (ICSA). The sample consisted of two hundred and forty-eight witness statements extracted from the 56 publicly available case studies presented to the Australian Royal Commission into Institutional Responses to Child Sexual Abuse during 2013-2016 (Commonwealth of Australia, 2017). A content analysis and thematic coding of the statements identified seven main themes in the witness statements (Gender, Organization, Triggers, Trauma, Mental Health, Intervention and Compensation), that appeared to be critical events across the life course. The themes were transformed into variables for further analysis using SPSS. Significant Likelihood Ratios were found between associations with the organization where the abuse occurred and between triggers and breastfeeding/sensory, breast feeding/childcare, emotional and physical distress, and mental health (p < 0.01). Significant associations were also found between receiving compensation for the CSA and triggers, trauma, breast feeding-sensory and childcare (p < 0.05) and gender and breast feeding (p < 0.05). Overall, the findings showed that triggers can be random across the life course occurring mainly through indirect association, or in situations that evoke memories of the CSA, and that receiving compensation can assist survivors in their recovery journey. The findings also indicate the need for health care professionals to be aware of the critical points in a CSA survivor's recovery and how triggers may impact on their mental welling throughout the life course.

Public beliefs about trauma and its consequences: Profiles and correlates of stigma

Public stereotypes about trauma exposure and its likely consequences have the potential to influence levels of support extended to survivors in the larger community. The current project sought to examine unique profiles of stereotype endorsement both within and across participants sampled from distinct populations. Trauma-related stereotypes involving symptom course, dangerousness, employability, social functioning, predictability, character, and treatment need were examined in undergraduate (N ₁ = 404; N ₂ = 502) and MTurk (N ₃ = 364) samples. Sympathizing [low overall endorsement], Fearful [high overall endorsement], Pejorative [high endorsement + moralizing beliefs], Safety-Focused [intermediate endorsement + dangerousness], and Performance-Focused [intermediate endorsement + employability] groups were replicated in latent profile models across all samples. Stereotype profiles demonstrated hypothesized associations with general perspectives of mental illness although support for consistent relations with respondent characteristics (e.g., sex; personal exposure to trauma; reported exposure in friends/family) was limited. Data suggest that trauma stereotypes are endorsed at high frequencies in the general community and conform to systematic patterns of prejudice that may be overlooked in more global assessments of stigma.

Adult and Adolescent Disclosures of Child Sexual Abuse: A Comparative Analysis

The recent attention focused on child sexual abuse (CSA) disclosure pathways has highlighted complex psychological processes that influence disclosure both for children and adults. Some authors have suggested that such processes may differ between children and adults yet few studies have examined distinct samples within the same study. This paper addresses this gap by exploring adolescent (n = 20) and adult (n = 10) experiences of disclosure of childhood sexual abuse. Interviews were conducted with both samples, using the same interview schedule and a comparative analysis was conducted of the key themes identified from a grounded theory analysis. Those themes that were found to be common to both samples included pressure cooker effect, telling would make it worse, and self-blame. Themes that were found to be more prevalent in the adolescent sample included police/court involvement, concern for other children, being asked, and peer influence. It is suggested that such potential differences reflect the changing social context over the past few decades which is characterised by increased awareness of sexual abuse as a crime and the risks of recidivism of offenders.

Nonoffending Caregiver Support After Child Sexual Abuse: Essentials for the Forensic Nurse

Child sexual abuse (CSA) is a pediatric health problem of epidemic proportions. CSA can result in significant lifelong physical and mental health consequences. A disclosure of CSA affects not only the child but also everyone close to the child. Nonoffending caregiver support after a disclosure of CSA is key to optimal victim functioning. Forensic nurses play an integral role in the care of CSA victims and are uniquely positioned to ensure best outcomes for both child victims and their nonoffending caregivers. In this article the concept of nonoffending caregiver support is explored, and = implications for forensic nursing practice delineated.

Survivor, family and professional experiences of psychosocial interventions for sexual abuse and violence: a qualitative evidence synthesis

BACKGROUND

It is well-established that experiencing sexual abuse and violence can have a range of detrimental impacts; a wide variety of interventions exist to support survivors in the aftermath. Understanding the experiences and perspectives of survivors receiving such interventions, along with those of their family members, and the professionals who deliver them is important for informing decision making as to what to offer survivors, for developing new interventions, and enhancing their acceptability.

OBJECTIVES

This review sought to: 1. identify, appraise and synthesise qualitative studies exploring the experiences of child and adult survivors of sexual abuse and violence, and their caregivers, regarding psychosocial interventions aimed at supporting survivors and preventing negative health outcomes in terms of benefits, risks/harms and barriers; 2. identify, appraise and synthesise qualitative studies exploring the experiences of professionals who deliver psychosocial interventions for sexual abuse and violence in terms of perceived benefits, risks/harms and barriers for survivors and their families/caregivers; 3. develop a conceptual understanding of how different factors influence uptake, dropout or completion, and outcomes from psychosocial interventions for sexual abuse and violence; 4. develop a conceptual understanding of how features and types of interventions responded to the needs of different user/survivor groups (e.g. age groups; types of abuse exposure; migrant populations) and contexts (healthcare/therapeutic settings; low- and middle-income countries (LMICs)); 5. explore how the findings of this review can enhance our understanding of the findings from the linked and related reviews assessing the effectiveness of interventions aimed at supporting survivors and preventing negative health outcomes.

SEARCH METHODS

In August 2021 we searched MEDLINE, Embase, PsycINFO and nine other databases. We also searched for unpublished reports and qualitative reports of quantitative studies in a linked systematic review, together with reference checking, citation searches and contacting authors and other researchers to identify relevant studies.

SELECTION CRITERIA

We included qualitative and mixed-methods studies (with an identifiable qualitative component) that were linked to a psychosocial intervention aimed at supporting survivors of sexual abuse and violence. Eligible studies focused on at least one of three participant groups: survivors of any age, gender, sexuality, ethnicity or [dis]ability who had received a psychosocial intervention; their carers, family members or partners; and professionals delivering such interventions. We placed no restrictions in respect of settings, locations, intervention delivery formats or durations.

DATA COLLECTION AND ANALYSIS

Six review authors independently assessed the titles, abstracts and full texts identified. We extracted data using a form designed for this synthesis, then used this information and an appraisal of data richness and quality in order to stratify the studies using a maximum variation approach. We assessed the methodological limitations using the Critical Skills Appraisal Programme (CASP) tool. We coded directly onto the sampled papers using NVivo and synthesised data using a thematic synthesis methodology and used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each finding. We used a narrative synthesis and matrix model to integrate our qualitative evidence synthesis (QES) findings with those of intervention review findings.

MAIN RESULTS

We identified 97 eligible studies and sampled 37 of them for our analysis. Most sampled studies were from high-income countries, with four from middle-income and two from low-income countries. In 27 sampled studies, the participants were survivors, in three they were intervention facilitators. Two included all three of our stakeholder groups, and five included two of our groups. The studies explored a wide range of psychosocial interventions, with only one type of intervention explored in more than one study. The review indicates that features associated with the context in which interventions were delivered had an impact on how individuals accessed and experienced interventions. This included organisational features, such as staff turnover, that could influence survivors' engagement with interventions; the setting or location in which interventions were delivered; and the characteristics associated with who delivered the interventions. Studies that assess the effectiveness of interventions typically assess their impact on mental health; however, as well as finding benefits to mental health, our QES found that study participants felt interventions also had positive impacts on their physical health, mood, understanding of trauma, interpersonal relationships and enabled them to re-engage with a wide range of areas in their lives. Participants explained that features of interventions and their contexts that best enabled them to benefit from interventions were also often things that could be a barrier to benefiting from interventions. For example, the relationship with the therapist, when open and warm was a benefit, but if such a relationship could not be achieved, it was a barrier. Survivors' levels of readiness and preparedness to both start and end interventions could have positive (if they were ready) or negative (if they were not) impacts. Study participants identified the potential risks and harms associated with completing interventions but felt that it was important to face and process trauma. Some elements of interventions were specific to the intervention type (e.g. faith-based interventions), or related to an experience of an intervention that held particular relevance to subgroups of survivors (e.g. minority groups); these issues could impact how individuals experienced delivering or receiving interventions.

AUTHORS' CONCLUSIONS

We had high or moderate confidence in all but one of our review findings. Further research in low- and middle-income settings, with male survivors of sexual abuse and violence and those from minority groups could strengthen the evidence for low and moderate confidence findings. We found that few interventions had published quantitative and qualitative evaluations. Since this QES has highlighted important aspects that could enable interventions to be more suitable for survivors, using a range of methodologies would provide valuable information that could enhance intervention uptake, completion and effectiveness. This study has shown that although survivors often found interventions difficult, they also appreciated that they needed to work through trauma, which they said resulted in a wide range of benefits. Therefore, listening to survivors and providing appropriate interventions, at the right time for them, can make a significant difference to their health and well-being.

My Sister's Keeper: Survivors Disclosing Sexual Violence to a Sibling

Siblings are often cited as a source of support throughout life, but they have not been included in studies of sexual violence disclosure. Survivors of sexual violence often delay or do not disclose their sexual violence. The current study investigated if and why survivors of sexual violence decided to disclose to their sibling. This qualitative investigation included 10 female participants, of which six had disclosed their abuse to their sibling. The participants ranged in age from 20 to 58, five identified as Hispanic, one as Hispanic and White three identified as White, and one identified as Middle Eastern. Thematic analysis was used to examine the data. Three major themes were identified that affected sibling disclosure decisions: sibling dynamics, perceived and real reactions to disclosure, and words of advice. The findings from this study demonstrate the continued need to investigate siblings and their role in disclosure of sexual violence. Practitioners may also want to examine the sibling relationship as a source of support for survivors of sexual violence. Finally, as policies continue to develop around support of survivors of sexual violence, inclusion of siblings in family policies, outreach centers, and counseling services may be beneficial.

Child Sexual Abuse and Suicide: Essentials for the Forensic Nurse

Sexual abuse can result in significant negative sequelae for victims. One particularly harmful consequence is suicidal ideation, which can lead to suicide attempts and even death. It is essential to screen children and adolescents for suicidal ideation when providing medical forensic care after disclosure of acute or nonacute sexual abuse/assault. Forensic nurses must feel confident in their abilities to assess suicide risk and provide appropriate intervention and referrals. A thorough understanding of the relationship between sexual abuse and suicidal ideation and behaviors can assist the forensic nurse in the development of practice behaviors to better identify, intervene, and prevent suicidal ideation and behaviors among youth experiencing sexual abuse.

Older immigrant Latino gay men and childhood sexual abuse: Findings from the Palabras Fuertes project

Childhood Sexual Abuse (CSA) and maltreatment have long-term negative impacts on survivors, including older adults. Yet, limited qualitative examinations of how these experiences impact the lives of older adults exists and even fewer among older Latino gay men. We drew data from life-history narratives the first author conducted with five Spanish speaking older Latino gay men in New York City. Our analyses were guided by an Ecological Model, a Suffering lens, and our clinical social work experience with older adults, sexual minorities and people of color. All participants reported sexual experiences prior to the age of 15 and possible emotional and physical maltreatment. Yet, not all participants perceived these experiences as abuse. Our findings indicate how cultural, linguistic and contextual factors may affect disclosure and coping. Despite the fact that CSA and maltreatment occurred decades ago, these early experiences affected long-term psychosocial functioning. Our findings support a need for future research and clinical practice that considers the subjective perceptions of childhood sexual experiences and maltreatment and how these relate to psychosocial functioning in Latino gay men during older adulthood.

"God, why?": The Experience of Mothers from the Israeli Ultra-Orthodox Sector after their Child's Disclosure of Sexual Abuse

Studies dealing with the experiences of non-offending mothers from the general population and minority groups after their child's disclosure of sexual abuse are scarce, and studies on mothers from the Jewish ultra-Orthodox community are non-existent. This study takes an initial step in filling this gap by exploring how the normalization of sexual abuse shapes these mothers' experiences. A qualitative phenomenological study was conducted on a sample of 21 mothers from the ultra-Orthodox sector whose children had been sexually abused. It consisted of in-depth, semi-structured interviews of the mothers followed by a drawing task on their experience. The analysis of the interviews yielded four central themes: the role of social stigmatization and religion on the mother's ability to share her child's abuse; the effect of the disclosure on the mothers' mental state and maternal competency; the mothers' ongoing experience in the shadow of this unprocessed/unresolved trauma; and the mothers' coping strategies, including acceptance, faith, and meaning making. The findings highlight the influence of the tension between the need to adhere to religious norms and preserve the social fabric and the need to enhance mothers' and children's well-being.

Online Sexual Solicitation of Children and Adolescents in a High-Risk Population

INTRODUCTION

The Internet provides a powerful potential tool for sexual predators. Experiencing trauma, including sexual abuse, can increase child and adolescent risk of experiencing online sexual solicitation.

METHOD

A retrospective chart review was conducted for the detailed information of all children and adolescents aged 8-18 years presenting to the Child Advocacy Center of large, tertiary care, Midwestern U.S. pediatric hospital with concerns of sexual abuse.

RESULTS

Three-hundred twenty-five children and adolescents were seen in the Child Advocacy Center during the 9 months; 139 (42.8%) denied talking to anyone online that they had not met offline (face to face in real life), 88 (27.1%) reported talking to individuals online that they had not met offline but never talking about sex; 65 (20%) reported online sexual solicitation with individuals they had not met offline; and 33 (10.2%) reported highest-risk behaviors online involving meeting someone offline or having sex with someone offline whom they had met online.

DISCUSSION

The number of youth involved in online sexual solicitation illustrates that children who have been sexually abused are at increased risk for sexual solicitation. This study also suggests that young children are vulnerable to online sexual solicitation. Youth engaged in these concerning online behaviors with individuals of all ages.

How can school help victims of violence? Evaluation of online training for European schools’ staff from a multidisciplinary approach

The interventions used to prevent or treat violence against children, particularly sexual abuse, tend to only consider the target audience as their main source of data. We tested the effect of an online training for school staff members in Europe through three studies. In Study I, we interviewed 5 adult women (Mage = 49.2, SD = 5.81) who were victims of sexual abuse during childhood to assess what school could have done during that time to protect them. Through Study II, we collected data on 66 school staff members to assess feasibility (based on quantitative indicators) and to explore the changes they would make to their everyday practice due to the training course (using qualitative analysis). In Study III, we used network analysis to assess to what extent the actions described by school staff in Study II met the needs expressed by the victims in Study I. Findings of Study I revealed new proposals from the victims’ perspective, such as working with the perpetrators. Study II showed the feasibility of training and identified five types of action that school staff members will include in their everyday working dynamics due to the training: detection (e.g., Greater attention to relationships with peers), reporting (e.g., Now I know that suspecting a case of child abuse is enough to report), everyday practices (e.g., Introducing a calming space), changes at school level (e.g., Propose the training course to the school management team) or practices that could belong to more than one category (e.g., Greater awareness of the activities undertaken by the school). Study III provided evidence that some of these changes (e.g., reporting without looking for proof) were in line with some of the victims’ expectations (e.g., listen to the children). We also identified gaps that need to be further developed.

Trauma Chronicity and the Long-Term Needs of Childhood Sexual Trauma Survivors

Research has linked childhood sexual trauma (CST) with adverse adult outcomes (AAOs) that span physical, psychological, and social domains of functioning. Differences in conceptualizing and measuring CST, however, have inhibited the examination of trauma-related variables hypothesized to impact adult outcomes. We used National Sexual Health Survey (NSHS; 1995–1996) data to examine trauma chronicity (i.e., duration) and AAOs (domains: physical and mental health, close relationships, and achievement). The NSHS (N = 6537, 18–70 years) assessed duration using perpetrator-specific CST reports. Adjusting for background characteristics, we examined CST duration in relation to AAOs and CST-related help-seeking. Approximately 8% of participants reported CST. Chronic (vs. single-exposure) CST survivors were at substantially higher risk of experiencing AAOs [i.e., mean AAOs and specific AAOs (e.g., physical and emotional health problems, divorce/separation, and poverty)]. CST had direct effects on sexual dysfunction and satisfaction, and on relationship stressors which may impact sexual relationship quality. Although 62% of CST survivors did not seek help, those with more chronic CST histories reported a higher prevalence of trauma-related help-seeking. Our work underscores the importance of examining CST chronicity in relation to long-term developmental outcomes. Chronicity assessment may be an important screening tool in the therapeutic context and in broader community screening efforts.

"You're going to look at me differently": A qualitative study of disclosure experiences among survivors of military sexual assault

Most survivors of sexual assault who disclose their experience do so within their social network. Prior research on disclosure among individuals who experience sexual trauma has mainly focused on childhood sexual abuse, college-aged women, or disclosure to formal sources of support (e.g., treatment providers). There is limited research on disclosure among veteran survivors of military sexual assault (MSA). The current qualitative study aimed to explore the disclosure experiences of treatment-seeking survivors of MSA. Participants were 17 veterans (n = 13 women, n = 4 men), aged 33-65 years, who reported experiencing MSA. During semistructured interviews, participants were asked about their experiences disclosing MSA to informal support persons (e.g., family members, partners, friends). A narrative thematic analysis identified 11 themes that emerged throughout different aspects of the disclosure, including (a) preparation and reason for disclosure (reactive or spontaneous disclosures, disclosure as an explanation/obligation), (b) expectations about the disclosure experience (no expectations, negative expectations grounded in socialized beliefs, positive expectations based on specific relationships, mismatch between experience and expectation), (c) the actual disclosure experience (negative experiences of personalization, supportive responses, share shame), and (d) military context (disclosing to another member of the military, reporting dynamics). Additional subthemes were nested within these categories. The findings indicated common experiences across participants, particularly regarding disclosure rationale. Key differences were largely influenced by contextual factors (e.g., response of the disclosure recipient). These findings hold implications for clinicians working with survivors of MSA who are preparing for and coping with the consequences of disclosure.

A Qualitative Description of Resident Physicians' Understanding of Child Maltreatment: Impacts, Recognition, and Response

Child maltreatment (CM) is a public health problem with devastating effects on individuals, families, and communities. Resident physicians have varied formal education in CM, and report feeling inadequately trained in identifying and responding to CM. The purpose of this study is to explore residents' understanding of the impacts of CM, and their perceptions of their role in recognizing and responding to CM to better understand their educational needs. This study analyzed qualitative data obtained from a larger project on family violence education. Twenty-nine resident physicians enrolled in pediatric, family medicine, emergency medicine, obstetrics and gynecology, and psychiatry training programs in Alberta, Ontario, and Québec participated in semi-structured interviews to elicit their ideas, experiences, and educational needs relating to CM. Conventional (inductive) content analysis guided the development of codes and categories. Residents had thorough knowledge about the impacts of CM and their duty to recognize CM, but there was less consistency in how residents understood their role in responding to CM. Residents identified the need for more education about recognizing and responding to CM, and the need for educational content to be responsive to training, patient and family factors, and systemic issues. Despite knowledge about the impacts of CM and laws pertaining to mandated reporting, residents reported challenges with responding to concerns of CM. Findings of this study emphasize the need for better training in response to CM. Future educational interventions should consider a multidisciplinary, experiential approach.

Public Attitudes Toward Institutional Child Sexual Abuse in Israel: The Case of Malka Leifer

This study examined Israeli public perceptions of institutional child sexual abuse (CSA) in the Malka Leifer case. Leifer is a Jewish ultra-Orthodox former Melbourne school principal who is wanted in Australia on CSA charges, after fleeing to Israel. Based on a qualitative analysis of 2,451 reader comments retrieved from four Israeli news websites and six public Facebook pages, the findings indicated diverse attitudes toward the alleged perpetrator, the ultra-Orthodox Jewish community, state authorities, and victims. All parties involved were criticized, but less so the victims. Criticisms included sociopolitical and gender stereotypes, and demonic attributions. Positive comments were directed at all involved, even the alleged perpetrator, and especially the victims. The results demonstrate the need to better understand CSA portrayals in cyberspace, as they affect both public and policymaker attitudes, and the importance of fighting prejudicial discourse about the ultra-Orthodox community, especially in light of its changing attitudes regarding CSA.

What Patients Prioritize for Research to Improve Their Lives and How Their Priorities Get Dismissed again

Health researchers increasingly work with patients in a participatory fashion. Active patient involvement throughout the research process can provide epistemic justice to patients who have often only had an informant role in traditional health research. This study aims to conduct participatory research on patient experiences to create a solid research agenda with patients and discuss it with relevant stakeholders. We followed a participatory research design in 18 sub-studies, including interviews and group sessions (n = 404 patients), and dialogue sessions (n = 367 professionals and directors in healthcare and social work, municipality civil servants, and funding agencies) on patient experiences with psychiatric care, community care, daycare, public health, and social work. Findings from the eight-year study show that four priorities stood out: attention for misuse of power and abuse; meaningful participation; non-human assistance, and peer support. Moreover, that: (1) patients, based on their experiences, prioritize different topics than experts; (2) most topics are trans-diagnostic and point to the value of a cross-disability approach; and (3) the priorities of patients are all too easily dismissed and require ethics work to prevent epistemic injustice. Long-term investment in a transdisciplinary community of practice offers a solid basis for addressing patient-centered topics and may impact the quality of life of people living with chronic illness, disability, or vulnerability.

"It Made Me so Vulnerable": Victim-blaming and Disbelief of Child Sexual Abuse as Triggers of Social Exclusion Leading Women to Homelessness

Although the association between child sexual abuse (CSA) and homelessness among women is well documented, few studies have investigated this topic from a feminist standpoint, examining the impact of sociocultural factors such as rape culture. Based on a qualitative life course approach, individual interviews were conducted with 21 women who experienced both CSA and homelessness. Participants were between 29 to 60 years old (M = 45 years of age). Analyses revealed that CSA disclosure experiences were characterized by victim-blaming and disbelief. Women's traumatic experiences were further aggravated by these types of reactions. Finally, CSA and negative social reactions to women's disclosures of CSA were perceived as the onset of social exclusion, which lead to their homelessness. This study shows how traumatic CSA experiences and negative social reactions to their disclosure can both contribute to social exclusion and isolation, and to homelessness through the internalization of rape myths. These findings support the importance of focusing on CSA prevention to reduce social exclusion and homelessness.

"It's Not a Great Boulder, It's Just a Piece of Baggage": Older Women's Reflections on Healing from Childhood Sexual Abuse

In this study, we explored older women's reflections on processes of healing related to childhood sexual abuse (CSA). We aimed to answer questions about how childhood trauma was integrated into the life story and to identify factors or coping strategies that aided, or hindered, healing. Participants within this study included 12 women who were aged 60 or older and had reported CSA as adults at the beginning of the research project, 25 years prior. Qualitative interviews were conducted exploring women's reflections on the place of CSA in their lives over time and factors the participants thought were helpful or unhelpful in being able to come to terms with the abuse. Data were analyzed using thematic analysis, which resulted in three themes related to processes of healing. The themes identified were need for resolution, thinking about it differently, and developing agency over disclosure. The findings show that some form of resolution was needed for the women to recover and move on from their experiences of CSA. The two key strategies used to reach this resolution were reframing their experience or drawing upon positive life philosophies. Decisions around disclosure were also an important part of the healing process, with the women developing an agency over if, and how, they talked to people about their experience. Those women who were not able to make sense of their experience continued to be influenced by the negative feelings and memories associated with the experience. Our findings have implications for health professionals working with those who have experienced trauma. They demonstrate that there are a number of ways that people heal from trauma and find personal resolution across their lifespan.

Sexual Abuse in the Orthodox Jewish Community: A Literature Review

Sexual abuse is a cross-cultural phenomenon related to multiple cultural contexts including religious affiliation. The Haredi, or Orthodox Jewish community (OJC), constitutes a significant minority group of the worldwide Jewish population, characterized by cultural conservatism, steadfast loyalty to the community, and strict religious behavioral codes. To date, only few empirical studies (as opposed to multiple media reports) have dealt with the issue of sexual abuse within the OJC. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a systematic review of the literature on sexual abuse within the OJC and its subgroups that addresses experiences and reports of victims, perpetrators, the Jewish and general community, and professionals in the North America, Israel, and Australia. Articles were collected from peer-reviewed databases and bibliographies; 13 quantitative and qualitative articles were included in the final sample. Three themes emerged: disclosure of sexual abuse, perceptions and attitudes toward the abuse, and its implications. Results indicated that alongside several findings that were specifically grounded in the context of closed collective or religious societies and the OJC in particular, most essentially reflected universal aspects of sexual abuse. The results suggest promoting context-informed interventions based on community knowledge and resilience, together with appropriate training in order to better understand the needs of the OJC and of closed communities in general.

Experiences of Disclosure and Reactions of Close Ones from the Perspective of Child Sexual Abuse Survivors: A Qualitative Analysis of Gender Specificities

The disclosure of child sexual abuse (CSA) is a complex process that remains partially understood, despite its crucial role in survivors' recovery. Gender specific experiences of disclosure have been little investigated while this information is crucial to better tailor interventions for survivors. This qualitative study aims to 1) explore survivors' experiences in disclosing to close ones, and 2) contrast experiences of male and female survivors. Fifty-one CSA survivors (25 women and 26 men) aged 18 years or older were recruited via community services for survivors. Two main categories emerged from thematic content analysis: 1) experiences of disclosure hindering CSA recovery or 2) ones fostering CSA recovery. Men felt ignored when their close ones were focused on their own emotions of indifference, helplessness and guilt toward CSA. Men felt guilty when confronted with reactions of blame for their own inaction or disempowered when pressured to remain silent or to forgive. Women felt ignored when their close ones showed anger toward their perpetrator. Women felt guilty when they were held accountable for CSA events or disempowered when pressured to take legal actions. Women, but not men, reported feeling considered through caring and heart-to-heart discussions. Recommendations for awareness messages and practitioners are discussed.

Growing Older in the Shadow of Childhood Intra-Familial Sexual Abuse: Women's Reflections on Parenthood Experiences Throughout the Life Course

BACKGROUND AND OBJECTIVES

The long-term effect of intra-familial sexual abuse for the survivors' parenting, rarely focuses on older women who are mothers of adult children. The aim of the present study was to explore the parenthood experiences of aging women survivors of intra-familial sexual abuse, using the life-course perspective as a conceptual framework.

RESEARCH DESIGN AND METHODS

Interpretive phenomenological analysis was used to analyze the narratives of 19 older women survivors of intra-familial sexual abuse.

RESULTS

The narratives revealed four themes: (1) "How did I raise those kids? I really don't know": Early parenthood experiences of aging women incest survivors; (2) "This is a true gift they are giving me now": Revealing the IFSA secret to the adult children; (3) "Is it possible to say that something good came out of it?": Adult children as a victory over incest experiences; and (4) "When my granddaughter was born, I suddenly felt that I couldn't go near her": Grandparenting in the shadow of incest memories.

DISCUSSION AND IMPLICATIONS

Aging seems to open up a new avenue for parent-child relationships in the shadow of the parent's traumatic past, allowing reframing of parenthood in later life and demonstrating the power of parenthood as a source of healing in the lives of sexual abuse victims.

Preadolescent Peer Sexual Abuse: A Systematic Literature Review

Child sexual abuse (CSA) is a worldwide social problem which has received much attention from policy makers, researchers, and practitioners. A considerable portion of CSA research has focused on adult offenders, the result of which is that most of our existing knowledge regarding prevention and intervention has been based on abuse perpetrated by this population. The current literature review, by contrast, was designed to spotlight the phenomenon of preadolescent peer sexual abuse (PAPSA), focusing on children ages 12 and under, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The results revealed scant empirical data, with only nine studies focusing on this phenomenon. As the basis of their investigations, most of the reviewed studies used definitions of sexual harassment among peers, rather than definitions of more severe forms of sexual abuse, and showed conflicting results depending on the ages and genders of the peers involved. In addition, prevention programs for peer sexual abuse/harassment were not targeted toward preadolescents. Additional findings indicated a lack of empirical knowledge with respect to core aspects such as victims' personal characteristics and subjective experience, the dynamic of the abuse, and the disclosure process. This systematic literature review emphasizes the need for an in-depth and thorough conceptualization and empirical examination of the PAPSA phenomenon and its unique characteristics.

How does COVID-19 impact intrafamilial child sexual abuse? Comparison analysis of reports by practitioners in Israel and the US

BACKGROUND

There is consensus in child sexual abuse (CSA) literature that intrafamilial child sexual abuse (IFCSA) has a tremendous impact on children and families while simultaneously creating challenges for practitioners. COVID-19 impacted countries worldwide and generated a global crisis resulting in impacts on daily life, however, it's effect on IFCSA is unknown.

OBJECTIVE

This study aimed to compare professional perspectives and experiences working with IFCSA with respect to the context of the COVID-19 pandemic within the United States and Israel.

PARTICIPANTS AND SETTING

Participants were therapeutic, child welfare and legal professionals, who provided services to children involved in IFCSA.

METHODS

This qualitative cross-cultural comparative study analyzes professional experiences of IFCSA during COVID-19 based on an open-ended questionnaire answered online, with 37 responses from the US and 23 responses from Israel.

RESULTS

Findings reveal mostly negative changes in the dynamics of IFCSA families during COVID-19, including financial, environmental, and emotional hardships, as well as some positive changes in the relationships among family members. In terms of professional interventions, concerns were raised that COVID-19 has been detrimental to the disclosure of IFCSA, with plummeting child abuse reports. Further, risk and benefits of transferring to internet based or telephonic therapeutic interventions were shared.

CONCLUSIONS

Governmental and community efforts are needed to develop a safety net of protective factors to reduce IFCSA risks and increase resiliency during the COVID-19 pandemic and future global crises. Moreover, enhanced strategies to accessing and supporting families remotely such as using technology could improve identification and response to IFCSA.