Excerpted from Transfer of Learning: A Tool for Child Welfare Supervisors
developed by Nancy Kail
CHILD MALTREATMENT IDENTIFICATION
DATE COMPLETED
PART 2: SEXUAL ABUSE AND EXPLOITATION
1. Review the handout in the trainee binder titled
Indicators of Sexual Abuse: Elements used to Identify
Child Sexual Abuse and Exploitation. Note the
physical, emotional and behavioral indicators of child
victims and their families. Using one of your cases, if
possible, what current or past indicators are/were
present?
2. Review the handout in the trainee binder titled Child
Rearing Standards and child Sexual Abuse in a
Cultural Context. Using one of your cases, if possible,
have a discussion about the cultural factors that may
impact assessment and intervention strategies.
3. Review the handout in the trainee binder titled
Personal Difficulties in Dealing with Sexuality and
Victimization. Have a discussion about your personal
values and bias related to child sexual abuse and
exploitation and how they may or may not affect
assessment and case planning.
4. Have a discussion about how cases of sexual abuse are
handled in your county. Does your county have a
protocol for sexual abuse investigations? What special
measures are taken during the sexual abuse
investigation, such as forensic interviewing, special
sex unit, etc?
5. Review the 3 handouts in the trainee binder titled,
Child Disclosures, Reluctance to Disclose, The NonOffending Parent/Caregiver and Myths & Research
about Sexual Offenders. Have a discussion about the
family dynamics in one of your sexual abuse cases, if
possible. Are/were the dynamics in your case
significant in identifying sexual abuse or exploitation?
6. Review the handout in the trainee binder titled
Treatment Issues. While there is no available
“formula” to determine whether and how long children
should be in treatment, every child and teenager who
is a victim of sexual abuse should be assessed by a
qualified professional to determine their mental health
status and needs. Using one of your sexual abuse
cases, if possible, have a discussion about the
assessment for treatment, treatment provided and
outcome of treatment. In general, what services are
available, in your county, for sexual abuse victims and
their families?
Trainee Content for Day 1, Segment 6
Indicators of Sexual Abuse:
Elements Used to Identify Child Sexual Abuse and Exploitation
This section of the curriculum outlines the elements that are examined to determine
whether sexual abuse has occurred. Many of these elements are often referred to as
indicators of child sexual abuse. The elements are divided into four broad categories:
 Reporting (including aspects of the allegation and disclosure);
 Physical (including medical indicators);
 Behavioral (including emotional indicators for the victim); and
 Familial (including family and caretaker dynamics).
Reporting Elements
Several elements must be considered that relate to the reporting of the allegation,
including the circumstances of the disclosure of the sexual abuse by the child or another
person.
1. Credibility of the report (and the reporter)
This element includes looking at a report and who reported it, and determining whether
the report is credible.
 Social workers should consider the clarity of the report, including whether the
reporter had direct knowledge of the incident, or whether they are able to provide
specific information as to time, place, etc.
 When evaluating a report of sexual abuse, the social worker should consider if there
is some advantage to an involved party related to the sexual abuse allegation. This is
most common in cases when sexual abuse allegations arise in the context of a divorce
and custody dispute.
 Consider the reporter’s motive for reporting. For example, a school social worker or
teacher might be perceived as credible while a parent engaged in a custody battle
might be much less so. More credible reporters may include medical personnel,
school staff, and mental health professionals.
 The alleged perpetrator or the non-offending parent may, individually or together,
attempt to undermine the credibility of the reporter or the credibility of the child’s
report. For example, they may attack the reporter and say the reporter has a vendetta
against the perpetrator.
2. Type and credibility of the child’s disclosure
The circumstances and type of the disclosure must be considered when attempting to
determine if sexual abuse occurred.
 A direct, unprompted verbal disclosure by the child is most highly correlated with
sexual abuse. Such disclosures may happen inadvertently or intentionally.
 The specificity of the disclosure is important. Disclosures with specific details about
where they were, what they were wearing, and what exactly the alleged perpetrator
did may be more reliable than vague disclosures that lack detail.
 Children will sometimes recant a disclosure of sexual abuse once they have made it,
depending on the response of their family or the person to whom they made the
disclosure.
 Often, children’s disclosures are tentative. They “hint” at what is going on (“I don’t
want to go home…”; “I don’t like my Dad anymore”; or “I know someone who….”)
to test the waters of how non-offending parents and other adults might respond.
 Disclosures made to a trained interviewer in a forensic setting (such as a multidisciplinary interviewing center) are more reliable, since the interviewer is
specifically trained to ask questions that do not influence the disclosure.
 It is also possible for children’s statements to be misunderstood because of
bizarre, fantasy-like, or implausible aspects of the disclosure. 1 Any disclosure of
sexual abuse, no matter how tentative or bizarre, should be evaluated seriously by
CPS and law enforcement.
More information on child disclosures will be covered in Segment 8.
CSA and custody dispute: CPS workers are frequently called upon to evaluate CSA
allegations in the context of custody and visitation disputes. Many investigators in CPS
and law enforcement question the credibility of allegations made under these
circumstances.
Reports of sexual abuse do increase during those times, for any number of reasons—
including the fact that the discovery of the abuse itself may have prompted the divorce.
Social workers should evaluate the validity of sexual abuse allegations that occur during
child custody disputes—by examining the particular information related to the case.
It is much more likely that children will deny true abuse than make false
accusations. 2
3. Corroboration of disclosure/report
1
For more information, see Everson, Mark (1997). Understanding bizarre, improbable, and fantastic
elements in children’s accounts of abuse, Child Maltreatment, Vol. 2, No. 2.
2
For more information, see Faller, 1991.
Corroboration is defined as the confirmation that some fact or statement is true through
the use of some kind of observable evidence. Since there is often no direct evidence of
sexual abuse, corroborating evidence often helps to confirm whether sexual abuse
occurred. Corroborating evidence should be observable.
Since sexual abuse is often shrouded in secrecy and coercion, the only two witnesses to
the event are generally the perpetrator and the victim. In some cases, however, someone
witnesses sexual abuse, and this should be considered.
 The statements and observations of other parties about the allegation may be
considered. This might include the statement of teachers, non-custodial parents, and
others who are able to verify some of the facts related to the report.
 The statement of the alleged perpetrator may be considered. If law enforcement has
obtained a confession or some other incriminating (or vindicating) statement from the
alleged perpetrator, this should be considered. Remember that interviews with
alleged perpetrators should be coordinated with law enforcement whenever possible.
 Other corroborating evidence, such as copies of letters/emails/text messages, pictures,
or videotapes should be considered.
 Corroborating evidence may support details about the case. For example, if the child
talks about it happening in a bed with Superman sheets, and those sheets are indeed,
in the closet, then that would be considered corroborating evidence. Other examples
of corroborating evidence include witness statements, medical exams, pictures of
bruises, and witness statements (e.g., a neighbor provides a statement that the stepdad
babysat the girls every Saturday morning).
 Corroboration could include verification/observation of injuries to the body (aside
from the genitalia) that were sustained during the sexual abuse. These might include
bruises or injuries sustained trying to restrain the child, for example (e.g., finger tip
bruises on arms). Injuries to the genitals are covered in Elements 6 and 7.
Corroboration of other facts related to the report should also be considered, such as
whether the alleged perpetrator and victim were together at the time of the alleged
incident.
4. Statements about prior unreported sexual abuse
 Of these children by any caregivers, or
 By these caregivers toward any children
For families that both are and are not involved with CWS, there may be a history of
unreported sexual abuse of the children or a history of unreported maltreatment by the
parents/caregivers of any children (in or out of the household). CWS social workers
should assess for possible unreported maltreatment history, not only to complete a
comprehensive picture in the identification process of child maltreatment, but also
because:
 these are important factors in the assessment of safety, risk, and protective capacity,
 these are important pieces of information to consider in the development of case
planning services for children, youth, and families involved with CWS, and

these factors may affect the eventual placement of the child(ren) with extended
family, friends, or non-relative foster caregivers.
Prior suspicions or allegations of sexual abuse may be more likely to go unreported, since
allegations of sexual abuse are considered taboo to discuss. This is also culturally
mediated, in that a family may have handled the prior report of sexual abuse without
involving the child welfare system (such as having the perpetrator attend church services,
sending the child or perpetrator away for a period of time, etc.).
Note: For this element, consider statements about sexual abuse that are not related to the
current report. The current report or allegation could be a longstanding abusive situation,
and this would not be prior abuse. Examples of prior unreported abuse would include
sexual abuse of the same child by another perpetrator, or sexual abuse of another child
under the care of the caregivers.
5. History of CWS Involvement
 With these children, and/or
 With these caregivers
Because of the family dynamics involved in sexual abuse, there may be sexual abuse in
the family that involves another family member or a member of the extended family who
has access to the children. In addition, prior reports of abuse and neglect in the family
may indicate lack of supervision, which would create an opportunity for a sexual
perpetrator to befriend or coerce a child victim.
 Prior CWS involvement indicates there is a higher risk of maltreatment. Review prior
records carefully to see if there is a pattern and to gain a thorough understanding of
the case history. In some cases, multiple allegations of sexual abuse have been made
on a family, or against a particular member of the family. A family with significant
resources to pay for legal services may be able to successfully have the cases closed
by the Juvenile Court, but multiple prior allegations may indicate that the alleged
perpetrator or non-offending parent are able to successfully cover up allegations of
abuse. CWS social workers should make sure to obtain as much information as
possible about prior allegations of sexual abuse, either in their county or another
jurisdiction.
 Prior Juvenile Court involvement indicates increased risk of maltreatment. This
indicates there were family issues and problems that required a high level of
intervention. It indicates a history of maltreatment to the child or a sibling of the
child.
 Children freed for adoption/never reunified indicates high risk. These include
children who were made dependents of the court for some type of maltreatment; the
parents were offered services for their return and did not substantially comply with
their reunification plan. Based on the history, this indicates a risk for other children
living with those parents.
 If parents have other children who are not living with them, this may be a risk factor.
Make sure to inquire if parents have had any other children who do not live with them
now.
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If parents have deceased children, make sure to include this information as well.
Inquire about and note the date, cause, and location of death. This can also be a risk
indicator.
Physical Elements
When a child has been physically involved in sexual activity, there may be physical
indicators or injuries that can be validated through a medical examination by medical
personnel trained in the identification of the signs of child sexual abuse. This is not true
in all cases, however; some children who have been sexually abused will have no
physical indicators of the abuse, even when a comprehensive forensic examination is
conducted within 72 hours of the alleged abuse.
6. Presence of illness or injury(ies)
This element refers to current illness or injury as a result of sexual abuse that can be
documented. These might include (adapted from Rycus & Hughes, 1998, p. 163):
 Physical injury to the genitals or another part of the body related to the circumstances
of the abuse (for example, marks or indicators of restraint)
 The presence of sexually transmitted diseases
 Suspicious stains, blood, or semen on the child’s underwear, clothing, or body
 Vaginal discharge, bleeding
 Genital pruritis (itching)
 Presence of a vaginal foreign body
 Recurrent bladder or urinary tract infections
 Early, unexplained pregnancy, particularly in a child whose history and behaviors
would not suggest sexual activity with peers
 Encopresis, constipation secondary to anal discomfort
These illnesses may or may not be discovered as part of a forensic medical examination
completed as part of the investigation and assessment of the allegations.
Note: Children who have been sexually abused often come to the attention of medical
professionals with general medical symptoms or somatic complaints, such as stomach
aches, insomnia, etc. These are considered under Element 15.
7. Report of past illness or injury (ies)
This element refers to past injuries or illnesses, as above, which were not reported or
recorded as sexual abuse at the time of occurrence. Examples of this might be a report by
a parent or other caregiver that they had noticed soreness or redness in the vaginal area
after previous contact with the alleged perpetrator, but had assumed that it was due to a
problem with hygiene. Conversely, a caregiver might report that the child has a chronic
rash in the genital area, and that they have been working with the pediatrician to address
the problem.
Whenever possible, the social worker should have the parent sign a release of information
form so that they can verify the information provided with the child’s medical provider.
8. Explanation of illness or injury (ies)
This element refers to the explanation given to the injury or illness. It is highly unlikely
that a young child would develop an STD accidentally, and injuries to the genital area are
fairly rare. Medical or nursing personnel with experience in evaluating sexual abuse
should be consulted when evaluating this element.
When attempting to determine whether sexual abuse has occurred, it is vital to verify all
the claims and explanations for illnesses and injuries. The information that you receive
from the parent may differ from the physician’s assessment, and this should be noted.
Information from a doctor or other health professional should also be assessed critically,
particularly if the health professional is not specially trained in sexual abuse.
 Some family physicians may not consider that sexual abuse is a possible cause of a
given medical condition, especially if they have a longstanding relationship with the
family.
 Conversely, some medical professionals may become convinced that sexual abuse has
occurred, when an alternative hypothesis appears more likely.
9. Developmental abilities of the alleged victim
The developmental ability of the victim may make them more vulnerable to coercion by
the alleged perpetrator, or make them more easily manipulated or threatened by the
perpetrator. Developmental abilities can refer to a child’s growth, motor skills (gross and
fine), cognitive development, verbal skills, and social/emotional development.
Vulnerability of the child should be considered. Of course, younger children have less
developmental abilities. Children who have impaired or reduced developmental abilities,
particularly in comparison to their peers, may have more vulnerability to abuse. This is
particularly relevant for children with delayed language skills. They may also be more
dependent upon their caregivers, thus increasing the power differential.
Children with impaired or reduced developmental ability have an increased risk of being
maltreated. Child maltreatment may affect development which in turn can precipitate
further abuse (American Academy of Pediatrics, 2001).
10. Developmental abilities of alleged perpetrator
Note: This element only applies when the alleged perpetrator is also a child.
Sexual behavior should be considered in light of the developmental level, rather than just
the age. In cases of sibling abuse, or sexual activity between an older child and a
younger child, the developmental abilities of the alleged perpetrator should be
considered. The impact on the victim should be the overriding concern when identifying
sexual abuse.
11. Medical assessment findings
Medical Evaluation of Sexual Abuse
An important part of the sexual abuse investigation is the forensic medical exam. In
California, law enforcement officers often authorize sexual abuse examinations as part of
their investigation. However, CPS workers may also authorize3 the exam and may
choose to do so even if law enforcement has declined, because the medical exam has both
physical and psychological benefits (see below). CPS workers should be familiar with
what the usual protocol is in their county for obtaining an exam. Many counties have
specialized, child-friendly pediatric sexual assault clinics as part of their county’s
Multidisciplinary Interview Center/Child Advocacy Center. Other counties perform both
acute and non-acute (see below) exams at hospital emergency rooms.
Types of Medical Evaluations
There are two types of sexual abuse examinations: acute evidentiary (immediate, sameday) and non-acute (as soon as possible after disclosure).
Acute examinations include:
 Collection and preservation evidence (semen, saliva, hair, fibers on clothes, etc.)
following a recent sexual abuse/assault episode (usually within past 72 hours,
sometimes longer);
 Evaluation, documentation, and treatment of any injuries;
 Evaluation for and prophylactic treatment for STDs and pregnancy; and
 Provision of crisis intervention services.
Most child abuse forensic examinations are of a non-acute nature (over 72 hours since
last incident of abuse/assault) because of the dynamics of delayed disclosure (discussed
above).
Non-acute forensic examinations include:
 Evaluation, documentation and treatment of any injuries;
 Evaluation and documentation of old or healing injuries/trauma;
 Provision of (post-disclosure) crisis intervention;
 Assurance of the physical and psychological well-being of the child.
When Should Children Be Referred for a Forensic Medical Examination?
There is a distinction between “authorization” and “consent.” Authorization refers to
the legal authority that requests that the exam be completed at public expense. Consent
refers to permission to perform the exam and release the results to those with legal
authority to obtain the results. Children over 12 must consent to the exam themselves,
but the exam should not be performed by force even on younger children. Refer to
Family Code 6927 and 6928 for further information on consent issues with minors.
3
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In all cases in which the most recent episode of abuse/assault occurred within the
last 72 hours (these children should be taken to an emergency room or 24-hour
evidentiary clinic). Note: Due to advances in forensics/evidence gathering
techniques, some jurisdictions perform forensic medical examinations after longer
intervals. When an assault has been disclosed, check with the forensic medical
practitioner to see if an immediate examination is warranted.
When there is a disclosure of penetration, regardless of time elapsed.
When there is evidence by history of pain, trauma, or infection, regardless of time
elapsed.
When the child has physical complaints related to the abuse.
If the disclosure is incomplete or the details are unclear and this might be clarified by
an examination.
When the child or family has questions that would best be answered by an expert
medical practitioner.
When the child would benefit from reassurance that he/she is “okay.”
In summary, the medical evaluation is a very useful tool for CPS workers. Children
benefit both physically and psychologically from the opportunity to meet with a medical
specialist to talk about their bodies. Medical examinations can also yield forensic
evidence that is admissible in both dependency and criminal courts, or medical examiners
can explain why the absence of findings may be consistent with a child’s statements. CPS
workers are encouraged to develop relationships with the medical evaluators in their
counties and to ask for explanations of the findings and the forms/documentation
associated with the sexual abuse medical exam.
Behavioral Elements
12. History of sexually abusive behavior by someone in the home or with access to
the child
This is perhaps the most important indicator of possible sexual abuse, aside from a clear
verbal disclosure by the child. Adults with a history of sexual interest in children are
very likely to re-offend, particularly without intensive treatment. The CWS social worker
should ascertain whether anyone who had access to the children has a history of sexual
behavior with children, either reported or unreported. The non-offending parent may or
may not have knowledge of the history of the perpetrator, and may or may not believe the
allegation (see Familial Elements).
Note: For this element, consider behaviors that are not related to the current report. The
current report or allegation could be a longstanding abusive situation, and this element
would not be relevant. This element would apply to sexually abusive behavior toward
other children, either within or outside the home.
13. Developmentally or socially inappropriate sexual knowledge and/or sexual
behavior
Non-abused children and sexually abused children may exhibit common sexual behaviors
(see the Toni Cavanagh Johnson charts earlier in this curriculum). This may make it
difficult to distinguish between sexual behaviors that appear to be the result of sexual
abuse and those that are not.
Sexual behaviors that are common for non-abused children include self-stimulating
behaviors, exhibitionism, and behaviors related to personal boundaries. Less frequently
seen behaviors in non-abused children are more intrusive, such as putting the mouth on
sex parts or putting objects into the vagina or rectum. Behavior that suggests a child’s
explicit or inappropriate knowledge of adult sexual behavior and compulsive
masturbation warrant further investigation.
The CWS social worker should pay special attention to the onset of a shift in behavior(s)
away from the child’s baseline, and whether this coincides with the onset of the abuse
that was alleged, or with the alleged perpetrator’s access to the child. An example of
such a shift in behavior is when a child’s clothing or style of dress changes from one style
to another (either more provocative style of dress or very covered up).
14. Self-protective behavior by the alleged victim
This element includes physical and behavioral methods that the victim uses to protect
themselves from the sexual abuse. The child may attempt to prevent the abuse from
happening long before the abuse is disclosed.
Examples of protective behavior might include:
 Attempts to make themselves as unappealing as possible sexually (e.g.,weight gain,
poor hygiene, etc.)
 Wearing layers of clothing to make body contact more difficult
 Refusal to visit the alleged perpetrator after the onset of the abuse, or attempts to
avoid unsupervised contact with the alleged perpetrator
 Temper tantrums when returning to the care of the alleged perpetrator
15. Indicators of emotional distress by alleged victim
Children who have been sexually abused may display a variety of indicators of emotional
distress. The presence of these indicators of distress does not in and of itself indicate that
a child has experienced sexual abuse, however. All of them are also signs of trauma or
distress that could be caused by other forms of abuse, or other sources of stress. The
indicators below are broadly grouped in terms of trauma-related indicators, depressionrelated indicators, anxiety-related indicators, and other indicators.
When evaluating these indicators, the CWS social worker should pay special attention to
the onset of the behaviors, and whether this coincides with the onset of the abuse that was
alleged, or with the alleged perpetrator’s access to the child.
Trauma-related indicators:
 Physiological reactivity/hyperarousal (hypervigilance, panic, and startle responses,
etc.)
 Retelling and replaying of trauma and post-traumatic play
 Intrusive, unwanted images and thoughts and activities intended to reduce or dispel
them
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Sleeping disorders with fear of the dark and nightmares
Dissociative behaviors (forgetting the abuse, placing self in dangerous situations
related to the abuse, inability to concentrate, etc.)
Cutting behaviors
Anxiety-related indicators
 Obsessive cleanliness
 Self-mutilating or self-stimulating behaviors
 Changed eating habits (anorexia, overeating, avoiding certain foods)
Depression-related indicators
 Lack of interest in participating in normal physical activities, loss of pleasure in
enjoyable activities
 Social withdrawal and the inability to form or to maintain meaningful peer relations
 Profound grief in response to losses of innocence, childhood, and trust in oneself,
trust in adults
 Suicide attempts
 Low self-esteem, poor body image, negative self-perception, distorted sense of one’s
own body
Other indicators
 Personality changes
 Temper tantrums
 Running away from home
 Premature participation in sexual relationships
 Prostitution
 Aggressive behaviors or irritability
 Regressive behaviors in young children (thumb sucking or bedwetting)
 Poor school attendance and performance
 Somatic complaints
 Accident proneness and recklessness
 Excessive piercings
 Dressing down, dressing in thick layers, padding or taping down genitals
 Perfect child/extremely high achiever/overly controlled/rigid
 Heightened sexualized behavior
 Indiscriminate sex
16. Coaching or grooming behaviors
The CWS social worker should try to determine if the perpetrator groomed or prepared
the child for the abuse, by providing special attention to the child, or by escalating the
type and intensity of sexual contact.
Gathering and assessing this information can be difficult, since grooming or coaching
behaviors are often subtle, and difficult to distinguish from normal expressions of care
and affection by adults. Sexual perpetrators often provide the same kind of attention that
is appropriate for a parent or grandparent to provide to children.
Sexually abusive adults often groom or initiate children by disguising their motives
through the use of games, secrets, toileting/bathing, and tickling and/or wrestling.
Offenders often “teach,” “help,” and “mentor” older children. They may treat children to
special gifts, special time, and special favors. They may use kid games (videogames,
Gameboy) and interests (sports, motorcycle riding) to connect with them and/or to use for
coercive purposes. They may also expose children to sexual talk and pornographic
movies to desensitize them to sexuality and have frequent physical contact (tickling,
wrestling, hugging, touching) to desensitize children to touch.
Familial Elements
17. Isolation of the child
The more isolated a child is socially and emotionally, the fewer opportunities they will
have to disclose abuse. Moreover, if they feel emotionally isolated, they may be less
compelled to disclose. A child who is socially or emotionally withdrawn may also
present a “safe target” for a perpetrator. But this isolation may also be a reaction to the
abuse.
This element also includes active attempts by the alleged perpetrator to keep the child
isolated from outside social contacts or influences that might cause them to disclose the
abuse. This might include physically isolating the child from outside contacts such as
social groups, school, church, etc. The child may also be isolated in the home, or even
self-isolating from his or her normal activities. The perpetrator might also engage in
isolating behaviors and have, for example, little contact with adult peers. Isolation
encompasses both the physical aspect of isolation as well as emotional separateness.
18. Coercion/threats made to the child to prevent disclosure
The perpetrator will sometimes threaten harm to the child if they disclose the abuse to
their parent or another adult. Threats might include, but are not limited to:
 Threats of physical harm to the child or the child’s family
 Threats to a treasured object of the child, such as a family pet
 Threats that the family will dissolve, or that the child will never see the alleged
perpetrator again (especially in cases of incest)
 Threats that appear fantastical to an adult, but may be believable by the child, such as
threats that the child will “go to hell” or that the perpetrator will use some sort of
supernatural powers to harm the child
 Threats regarding the safety of the family
 Promises of gifts
Other coercive behaviors may also be present, such as bribes or special prizes given to
the child by the perpetrator in exchange for keeping the “secret” of the abuse.
A non-offending parent who does not believe that the abuse occurred may threaten the
child as well.
The CWS social worker should pay special attention to coercion and threats when
children appear extremely anxious and fearful about the disclosure, or make frantic
attempts to recant their previous disclosure. A forensic interview may be able to sort out
whether threats or coercion were evident.
19. Current caregiver’s substance abuse
A significant number of children in this country are being raised by parents with
addictions. With more than 1 million children confirmed each year as victims of child
abuse and neglect by state Child Protective Service agencies, state welfare records have
indicated that substance abuse is one of the top two problems exhibited by families in
81% of the reported cases4. Cases of sexual abuse may also involve substance abuse by
the parent or guardian.
 Children may be poorly supervised by parents who are under the influence, out
looking for drugs, passed out, and coming down off of drugs, or who leave children
unattended when under the influence. The inebriated or high parent may leave
children in the care of inappropriate caregivers who may subject them to physical
abuse, sexual abuse, or neglect. Parents who are under the influence have
compromised judgment and compromised ability to provide appropriate nurturing,
care, and supervision to children.
 Loss of impulse control by parents/caregivers under the influence can lead to violence
and abuse, including sexual abuse. There may be an overlap with domestic violence
and substance abuse.
 People may lie/minimize while under the influence of drugs or alcohol.
20. Opportunity for the abuse to occur
When identifying whether sexual abuse occurred, the CWS social worker must consider
the opportunity that the alleged perpetrator had to abuse the child. This includes the
home environment, and the capacity of the non-offending parent to perceive that the
abuse may be occurring and protect the child if they suspect that it is.
The non-offending parent may have a great deal of difficulty recognizing the possibility
of sexual abuse, even when it seems obvious to an outsider. The alleged perpetrator may
hold great emotional power over the caregiver, with the result that the caregiver might
not be able to see sexual abuse as a possibility. Examples of this might include when the
alleged perpetrator has very high status in family’s community, such as a church elder or
a community leader.
There may be lack of boundaries in the home, such as no set sleeping locations or the
child/ren not having their own bed/space or privacy.
4
National Association for Children of Alcoholics. (1998). Children of alcoholics: Important facts.
Rockville, MD.
The non-offending caregiver may also have to work long hours, and may not have the
resources to provide licensed child care for supervision of the child.
Note: This element is often more important in determining that sexual abuse did NOT
occur, i.e., in cases where there was no possibility of contact between the alleged
perpetrator and the alleged victim. This is because most children are alone with other
children or adults at least part of the time. This does not mean that sexual abuse may
occur, unless there are other circumstances that make the opportunity particularly
striking. These might include, for example, a parent who refuses to supervise a child or
children even in a situation that might be sexualized.
Trainee Content for Day 1, Segment 5
Child Rearing Standards and Child Sexual Abuse in a Cultural Context
Sexual Behaviors in a Cultural Context
Before the worker can identify any behavior as abnormal, it is important to become
familiar with the normal sexual development, related behaviors, interactions, and feelings
of the growing child. It is important to remember that no child will follow these
developmental stages exactly. Deviations in behavior do not necessarily indicate a serious
problem or sexual abuse in particular, but they should be assessed in the context of the
history, physical findings, and the child’s family environment (Hillman & Solek-Tefft,
1988).
Child Rearing Standards in a Cultural Context (refer back to CMI-1)
The definition of child abuse has changed over time and varies according to the values
and beliefs of the majority culture. Thus child maltreatment can be viewed in a cultural
context as a reflection of the time and area in which we live. Child rearing standards in
general also may be viewed in a cultural context. What defines good parenting today
differs significantly from times past. What is considered optimal parenting also varies by
the culture, time, and place in which one lives.
Child Sexual Abuse in a Cultural Context
In non-clinical studies, Caucasian and African-American women have similar rates of
abuse with Asian rates slightly lower. Latinas are at increased risk for incest. The reasons
for these cultural differences are not clear (Fontes, 2005).
Cultural Aspects of Shame in Child Sexual Abuse:
Responsibility for the abuse
 The assignment of responsibility for the abuse can vary widely across cultures. In
many traditional cultures, sexual relations are viewed as a fundamental struggle:
something females should try to avoid and males of all ages should try to obtain.
Where sexual acts have occurred outside marriage, the girl or woman is assumed to
have made herself accessible and is often held responsible, even when there is a
difference in age or power between the people involved. A Peruvian woman
described how her brother had been found to be having sexual relations with his 9year-old stepdaughter, and how the girl was banished to a convent. “It wasn’t his
fault!” she insisted. “The girl was right there with him and was very pretty. She wore
short dresses. She sat on his lap. She asked him to tuck her in at night. Her mother
was away for a month. He couldn’t help himself!” (Hillman & Solek-Tefft, 1988).
 It is important for workers to understand cultural norms around the assignment of
blame and responsibility. At the same time, professionals need to help their clients
place responsibility for past incidents on the shoulders of the perpetrator, and ensure
that different family members take responsibility for future protection of the child.
Failure to protect
 Nonoffending family members are often ashamed of having failed to protect a child
from sexual abuse-thereby having proved themselves inadequate in a key task of their
cultural roles as mothers, fathers, older brothers, etc. A man whose child has been
victimized may feel like a failure as a man; his sense of failure could drive him to
physically attack the perpetrator to recover his feelings of dignity and self-worth.
 Professionals need to show fathers and other concerned adults ways in which they can
actively and positively participate in the child victim’s recovery and protect other
children (Pearce & Pezzot-Pearce, 1997).
Fate
 People with a culturally fatalistic view, believing that forces outside or beyond an
individual determine the life course, will often respond quite passively to the
discovery of sexual abuse. This world view is unlikely to be changed.
 The worker can ask each person involved, “How do you explain why the abuse
happened?” in an effort to determine if they see fate as the reason for the abuse. A
worker can then follow up with a statement such as:
o “Thank you for letting me know how you explain what happened. I’d like to
suggest a couple of other ideas, so you can know how I think about it. I expect
that both perspectives contain some truth. ____________ chose to abuse your
child because______________ has sexual feelings toward children, and found a
way to be alone with your child and act on those feelings. We can work together
to help your child and family recover from this, and to make sure nothing like this
happens again. I encourage you to continue to do all the things you are doing to
help you to cope [e.g. praying]. I have ideas about other things that could be
helpful to you and your child too, and have been helpful to other people in your
situation” (Fontes, 2005, pp.143-145).
Damaged goods
 There is a sense of being “soiled” or “spoiled” and the child may come to believe they
are “dirty” as a result of the abuse. If the knowledge of the sexual abuse were to
become known in their community, the family and child might be ostracized and
considered unworthy. The girl victim might also lose her potential value as a future
wife and daughter-in-law, an important part of a grown woman’s identity in many
cultures around the world.
Virginity
 Many cultures control women’s sexuality by expecting girls to maintain their
virginity until marriage. This expectation includes traditional families from many
parts of Asia, Africa, Europe, the Middle East, and the Americas. In some traditional
cultures, a girl who has engaged in any kind of sexual activity, even forced, may well
be perceived as losing her virginity, and thereby be considered either not suitable for
marriage or of lesser value as a bride.

“In many places the absence of virginity may mean that a young girl loses her chance
for marriage. If the situation is known, she loses her prestige within the family [just]
as the family loses it in their close neighborhood…Sexual abusers seem to pay
attention to this issue, and some girls are threatened with “losing their hymen” which
explains [the elevated presence of] nonpenetrating sexual abuse. On the other hand,
the first reaction of the nonoffending parent and other relatives is to take the child or
young girl for an examination of her virginity, when they find out about the abuse. If
the hymen is left intact, the sexual abuse cannot be proved, and this makes the denial
easier for the family. Professionals, therefore, emphasize that fact that the presence of
the hymen does not preclude sexual abuse” (Yuksel, 2000).
Predictions of a shameful future- promiscuity, homosexuality, and sexual offending
 People from many cultures believe that girls who have suffered sexual abuse are
likely to become promiscuous and boys who have been sexually abused by men are
likely to become either homosexuals or sexual offenders. There is no indication that
sexual abuse will influence a boy’s later sexual orientation (Arey, 1995). Boys who
have been sexually abused appear to engage in more sexual behaviors, such as
masturbation, sexual play, and sexual aggression with younger children, than boys
who have not been sexually abused (Friedrich, Grambsch, Damon, Koverola, Hewitt,
Lang, & Wolfe, 1992).
Re-victimization
 In some cultures, when a girl is known to have been sexually abused, she has lost the
special protective aura of virginity and is considered to be “fair game” for other men
to try to seduce or assault. Russell (1986) suggests that knowledge of prior
victimization may disinhibit some perpetrator’s abusive tendencies toward these girls.
Grauerholz (2000) describes a variety of reasons why girls and women may be more
likely to suffer further experiences of sexual assault following sexual abuse in
childhood: continued exposure to the factors that put her at risk in the first place,
lessened ability to detect danger, and the use of substances that inhibit her ability to
avoid dangerous situations or to escape from them.
Layers of shame
 There are factors which the individual might already feel a sense of shame about
because they are not congruent with what is valued by the majority culture, such as
skin color, hair texture, eye shape, or social status. The sexual abuse and its
consequences magnify these factors (Fontes, 2005).
Gender and Role Differentiation Issues Influencing Child Sexual Abuse
Double Standard between Male and Female Children:
In almost every society, expectations of and for male and female children are different.
This difference is frequently reflected in the expression of sexual behaviors. When we
talk about the sexual victimization of children, if you have a 12 year old girl who is
molested by a 25 year old male, no one has a problem in seeing the girl as a victim of
sexual abuse or exploitation. In general, child protection and law enforcement systems
will move to protect the child and hold the perpetrator accountable for the violation of
criminal laws. If the child is a 12 year old boy and the perpetrator is a 25 year old
woman, there is much more ambivalence in viewing the boy as a victim, and in fact,
many may see him as “lucky”. Within some cultures this may be seen as a desired part of
his development as a man. The protection and enforcement systems may be slower to act
to protect, the family may be less supportive of such intervention, and the child not seen
in need of therapeutic services.
However, if the 12 year old boy has been molested by a 25 year old male, the paradigm
shifts and the child is now without question, the victim, and the adult responsible, an
offender. The protective systems come in rapidly and act to protect, the family feels a bad
thing has happened to their son, and the belief is that without therapeutic intervention the
child may suffer long term, potentially severe, consequences. There is also the additional
concern he will become either a perpetrator himself, or, within some cultures, a
homosexual (Fontes, 2005). The scenario of the 12 year old female being molested by a
25 year old female is rarely considered.
The double standard also is reflected in the behaviors considered “normal” or appropriate
for a child or adolescent within that culture. As noted in earlier classes, culture is
evolving, and the norms, including sexual norms, change over time. In general, males
have more freedom and are allowed a wider expression of sexual behaviors than females,
with fewer repercussions or sanctions when they violate cultural or community norms.
The value of a boy or man’s masculinity may hinge on the number of his conquests, and
the value of a girl or woman’s femininity may hinge on her chastity (Fontes, 2005). It
may be difficult for families to assign responsibility appropriately in cases of brothersister incest, particularly in cultures that value boys more highly than girls. Parents
frequently minimize or deny the significance of brother-sister incest, or they blame the
girl (Fontes, 2005).
Sexual Orientation – Gay, Lesbian, Bisexual, Transgendered & Questioning Youth
What is allowed in terms of expression or exploration of sexual identity also varies
between cultures, ages, and genders. “Expectations for gender roles and heterosexual
activity are communicated overtly and covertly and are the ways and means through
which girls and boys learn the values, beliefs, and customs of conventional masculinity
and femininity” (Ungar, 2005, p. 266). Same sex experimentation may be more expected
and/or excused among younger children or one gender. Because homophobia and
heterosexism continue to be largely unchallenged in contemporary society, lesbian, gay,
bisexual, transgendered, and questioning (LGBTQ) youth frequently face overt
discrimination without intervention from others. The Gay, Lesbian, and Straight
Education Network’s survey of LGBTQ students across the United States reported that
83% had been verbally harassed and 42% had been physically harassed in school, with
84% of high school students hearing the words faggot or dyke in the classroom frequently
or often (Ungar, 2005). This peer isolation, added to family lack of acceptance may
increase the child’s search for love and acceptance in unsafe ways with individuals more
predisposed to abuse or exploiting them.
Trainee Content for Day 1, Segment 2
Personal Difficulties in Dealing with Sexuality & Victimization
Emotional reactions to child sexual abuse is normal and to be expected. However, it is
important to recognize our emotional reactions to prevent them from impairing our
professional judgment or performance of our duties as child welfare workers. Despite
education and training, which specifies how to perform our professional roles, it is
normal for each of us to have personal reactions to our work. Child sexual abuse probably
arouses more personal reactions than many of the problems we encounter. Although these
may become less intense over time, they do not disappear. Initially, the enormity of
sexual abuse is likely to engender one of two opposing responses—disbelief or belief
accompanied by an intense desire for retribution.
Gender
The gender of the professional is likely to influence reactions to cases of child sexual
abuse. Both male and female professionals have empathy for victims. However, it is
possible that gender identification causes each to be more sensitive when the victim is of
his or her own gender. Professional reactions to sexual abuse may differ by gender
because men and women experience living in society differently.
Life Experiences
Many life experiences can intrude upon professional practice, and working in sexual
abuse can intrude upon a professional’s personal life. Three personal issues that seem
particularly salient are: having been sexually victimized, being a parent, and sexuality.
Sexual Victimization
A professional who has been sexually abused her/himself or who is part of a family in
which there has been sexual abuse must cope with this personal issue as well as with the
other stresses of work associated with working with sexual abuse survivors. Persons who
have sexual victimization in their background bring special sensitivity and experience
that can be of great value in their work. Nevertheless, professionals who have personal
experiences of sexual abuse need to have addressed these in therapy, be especially aware
of countertransference issues, and be alert to the importance of protecting their own
mental health.
Warning signs that the professional’s own victimization is impeding performance can
include:
□ Feeling so overwhelmed by fear, anxiety, disgust, or anger that the victimization
interferes with sound decision making or intervention or evokes the strong desire for
retribution;
□ Experiencing intrusive thoughts or having flashbacks at work;
□
□
□
Recalling previously repressed memories of victimization when involved in cases of
sexual abuse;
Displaying overly punitive responses to the non-offending parent or offender; and/or
Minimizing or not seeing the safety issues involved in a case, or the severity of the
effects on a child.
Being A Parent
The experience of parenthood can affect one’s reaction to a case of sexual abuse, and
working with sexual abuse can influence parenting. Parenthood can make the
professional more appreciative of the risks as well as more appalled at the transgressions
of the parenting role. Parents are confronted with many situations in which the child’s
behavior (e.g. wanting to sleep in bed between the parents) and parenting responsibilities
(the need to assist the child in bathing, toileting, and understanding the differences
between male and female anatomy) can present risks for sexual activity.
Sometimes, professionals who are parents are less willing to label client behaviors as
sexually inappropriate because of their over-identification with the client as a parent. For
example, a professional who is a father may minimize genital contact between an alleged
offender father and his daughter, accepting the explanation that the daughter was being
helped to learn about “wiping herself.”
Conversely, certain biological drives and normative proscriptions inhibit sexual activity
with children for parents. Because of these personal experiences, parents may be more
censorious than non-parents when these boundaries are crossed. Individual families will
have differing norms for what are acceptable personal boundaries or privacy, male and
female roles in parenting behaviors, and acceptable discussions around perceived or real
sexual matters.
In terms of work influencing parenting, a common effect of professional involvement
with sexual abuse cases is for the parent to become quite concerned about the risk of
his/her own children being sexually abused or exploited. Parents may be hypervigilant to
behavioral or physical indicators exhibited by their own children, such as urinary tract
infections, masturbation, enuresis, and sleep disturbances.
Comfort and History with Sexuality
Being familiar and comfortable with all aspects of sexuality is essential in working in the
field of child sexual abuse. For the professional, this means being able to talk freely about
all types of sexual issues.
Professional involvement with cases of sexual abuse very frequently has an impact on
personal sexuality.
Coping with Personal Issues
The best way to prevent personal reactions from undermining the quality of professional
work is to be aware of their existence. Once these reactions are identified, several
methods can be used to help to mitigate them, including:
□
□
□
□
□
Self-talk, in which the professional reminds him/herself of personal biases and
reactions.
Talking about, acknowledging and processing personal reactions and feelings about
cases with a supervisor, mentor, or trusted colleague. (Note: Remember that all case
information is confidential; child welfare workers need to request time with someone
within the agency, such as your supervisor, to discuss any detailed information.)
Using established guidelines and research to guide decision-making.
When possible, using collaborative decision-making with colleagues involved in the
case.
When the above suggestions are not sufficient, talking about, acknowledging and
processing personal reactions and feelings about cases with a counselor or therapist.
Avoiding Burnout
There is no denying that work in the field of sexual abuse is extremely stressful and may
lead to burnout. There are several characteristics of cases that make the work potentially
Trainee Content for Day 1, Segment 8
Child Disclosures, Reluctance to Disclose
Child disclosure of sexual abuse has generated controversy, with great debate in the press
and the academic community about the validity of children’s disclosures. Many studies
have methodological problems, and/or small sample sizes, exacerbating the controversy.
Only recently has a body of research emerged and analyzed that provides some guidance
for child welfare practitioners. Olafson and Lederman (2006) provide perhaps the most
comprehensive analysis and summary of the available research in their article, The State
of Debate About Children’s Disclosure Patterns in Child Sexual Abuse Cases. Their
summary of research findings are excerpted below, with some clarifying definitions
inserted.
Summary of Research Findings on Disclosure of Children Regarding Their Sexual
Abuse
1. Experts agree that a majority of child sexual abuse victims do not disclose their abuse
during childhood.
2. Experts agree that when children do disclose sexual abuse during childhood, it is
often after long delays.
3. Prior disclosure predicts disclosure during formal interviews. Children who have told
someone about the abuse prior to the formal interview are more likely to disclose
during the interview than children who have not. Children who have not previously
disclosed and who have come to the attention of the authorities because of medical
evidence, videotapes, and other external evidence, are less likely to disclose during
medical or investigative interviews than are previously disclosing children.
4. Gradual or incremental disclosure (where a child may disclose only aspects of an
abusive event during the initial interview) of child sexual abuse occurs in many cases,
so that more than one interview may become necessary.
5. Experts disagree about whether children will disclose sexual abuse when they are
interviewed. However, when both suspicion bias (cases which come to the attention
of the authorities because a child disclosed to someone prior to the formal interview)
and substantiation bias (substantiation was completely independent of the child’s
statements) are factored out of studies, studies with external corroborating evidence
of child sexual abuse show that 42% to 50% of children do not disclose sexual abuse
when asked during formal interviews.
6. School-age children who do disclose are most likely to first tell a caregiver about
what happened to them.
7. Children first abused as adolescents are most likely to disclose than are younger
children, and they are more likely to confide first in another adolescent than to a
caregiver.
8. When children are asked why they did not tell about the sexual abuse, the most
common answer is fear. (We need to ask children in the child interview what they
are afraid will happen if they talk about what happened when…)
9. Further research is needed about recantation rates, which range in various studies
from 4% to 22%.
10. Lack of maternal or paternal support is a strong predictor of children’s denial of
abuse during formal questioning. Abuse by a family member may inhibit
disclosure. Dissociative and post-traumatic symptoms may contribute to nondisclosure. Modesty, embarrassment, and stigmatization may contribute to nondisclosure. Gender, race, and ethnicity affect children’s disclosure patterns.
11. Many unanswered questions about children’s disclosure patterns remain, and further
multivariate research is warranted.
Intentional and Accidental Disclosure
Sgroi (1982) suggested two types of disclosures are encountered—the purposeful and
the accidental. In the former, the child makes the conscious decision to tell of the abuse.
In accidental disclosures, the child has made no overt statement to anyone with the
intention of seeking intervention. The accidental class of disclosure includes such
allegations as those involving sexually explicit play on the part of a preschooler, a
pregnancy in a very young adolescent, a child presenting with a sexually transmitted
disease, the purposeful disclosure of a child victim who names other child victims, or the
observation of the perpetrator-child sexual activity, including the interception of child
pornography.
Where the child has made a purposeful (deliberate) disclosure to an adult, the initial CWS
interview with the child is more likely to yield a more detailed description of the sexually
abusive activity. Even when there is independent evidence or information for the sexual
abuse or exploitation, the child interview might not yield a disclosure if the child has not
cognitively made the decision to tell. Research indicates that multiple interviews are
frequently necessary for a number of children to feel safe or comfortable enough to
disclose.
Trainee Content for Day 1, Segment 8
The Non-Offending Parent/Caregiver
Much research has demonstrated that the non-offending parents’ ability to provide
support following a disclosure of sexual abuse is the most critical factor influencing the
child’s post-disclosure adjustment. Non-offending parents may be viewed on a
continuum. They range from those who, prior to disclosure, have knowledge of the abuse
and do nothing, to those who “sense” something is not right but do nothing, to those who
recognize potentially abusive actions and are proactive in protecting the child. Postdisclosure responses range from those who align with the perpetrator and do not believe
the child to those who immediately believe and take protective action upon hearing a
disclosure.
In her book, The Mother’s Book: How to Survive the Molestation of Your Child (1992),
Carolyn Byerly lists these diverse reactions of non-offending parents after a disclosure of
child sexual abuse:
 Numbness
 Jealousy
 Distance
 Sexual inadequacy or rejection
 Anger
 Religious concerns
 Disbelief
 Minimizing the seriousness
 Denial
 Revenge
 Shame
 Financial and other fears
 Invisibility
 Hatred
 Guilt and self-blame
 Repulsion
 Hurt and betrayal
 A desire to protect him (the alleged
 Confusion and doubt
offender)
It is difficult to predict how a particular parent will react. Responses may also reflect
cultural components as well as the non-offending parent’s role in the relationship. Crosscultural marriages and dependency issues may also color both immediate and long-term
responses. Although not all parents experience significant distress following a disclosure
of sexual abuse, many do. Some parents may experience emotional distress and
depression which can be related to loss of income and financial support, changes in
relationships with family and friends, and disruptions in employment and living
situations.
There is growing evidence that when mothers are incapacitated in some way, children are
more vulnerable to abuse. That incapacitation may take a variety of forms. When a
mother is absent from a family due to divorce, death, or sickness, children appear to
suffer more abuse. Mothers may also be psychologically absent because they are
alienated from their children or husband or are suffering from other emotional
disturbances, with similar consequences. Mothers may be unable to protect children
because they themselves are abused and intimidated. Even large power imbalances that
may stem from differences in education may undercut a woman’s ability to be an ally for
her children (Finkelhor, 1984).
When non-offending caregivers first learn about the abuse, their reactions vary
considerably. The majority of mothers believe their child’s allegations, either totally or in
part, and most take some protective action. However, a substantial number did not
believe their children’s allegations and did not take protective action. Some were in the
middle; although ambivalent about the allegations, they took protective action anyway.
Elliot & Carne’s (2001) study examined a history of abuse on non-offending parent
reaction post-disclosure. The study examined four factors to see if parental belief,
support, and protection can be predicted. These factors include: mother’s relationship
with the perpetrator; mother’s own history of childhood abuse; victim’s age; and victim’s
gender. Anecdotal experience suggests that sometimes a parental history of sexual abuse
or victimization may influence whether her ”radar” responds to warning signs that abuse
may be happening. Some mothers who never disclose their own abuse or did not receive
treatment may deny abuse because, by acknowledging it in their children, they must
acknowledge their own history. Most of the above factors yielded inconsistent results,
though some studies indicate that young children are believed more often than older
children and adolescents.
A parent who has introduced the perpetrator to the child or family, such as the single
mother who is dating, may experience denial, guilt, or depression upon hearing the
child’s disclosure of sexual abuse. A mother may go through stages analogous to those
experienced by individuals who are dying, before she comes to believe the child. Denial,
guilt, anxiety, fear of repercussions, or depression may decrease the mother’s ability to
help the child cope with the traumatic experience.

Denial. Denial is a defense mechanism used to avoid psychic trauma or painful
reality. Denial can cause reactions such as: “No, not me, not my child, not my
husband, etc., etc. There must a mistake. My child must be making this up for some
reason.” Instead of immediately being labeled as non-cooperative, it is important for
child welfare workers to distinguish between a normal, initial reaction of disbelief,
which indicates a need for support and service, and chronic denial. As the literature
above notes, even parents who are non-believing or in denial can take protective
measures.

Anger. In the grief cycle, people need to blame someone outside themselves for their
painful situation. Anger may be directed at themselves for not seeing the abuse, at
the child for participating, at CWS and law enforcement for their involvement, at the
“situation,” and, appropriately, at the perpetrator. (Note: Anger may be due to lack
of understanding about the dynamics of sexual abuse. Anger at the child that persists
despite the passage of time or following education and support may be an indicator of
inability to provide support or protection, requiring CWS intervention).

Bargaining. During this phase, the parent tries to regain some emotional stability.
Feelings may alternate between “positive” actions such as reporting, seeking therapy,
kicking out the perpetrator, etc., and “negative” actions such as continuing to seek
alternative explanations, believing the child while allowing the perpetrator to retain
access, thinking they can handle it within the family, etc., and making inconsistent
statements to the child, e.g., “I believe you, but I also can’t believe your uncle is
lying.”
Note: It is very important that child welfare workers make efforts to explore and
understand the motivations behind seemingly negative actions. Sometimes, parents
are doing what they think is best for the child, as in families who would otherwise be
homeless or without any means of financial support or families with domestic
violence and the mother fears that the father may injure or kill her or the children.
Families may also respond in a particular way because of deeply held cultural or
religious beliefs or out of fear of the system response. (See section on cultural
issues.) Understanding these motivations provides windows into important points of
service intervention.

Depression. This is a very painful and uncertain period as the full magnitude of what
has happened sinks in. Depression can be debilitating as the parent feels that her
whole life is defined by the abuse, and is unable to see a future where this will not be
the case. It may be difficult for her to be emotionally supportive of her child because
of her own pain. For non-offending parents with their own history of abuse, this
phase can include a recapitulation of their own abuse experience. (Note: This stage
can be a powerful point of intervention if the parent receives support.)

Resolution. In this final stage, the parent begins to put the pieces of her life back
together, can envision and begin to create a future. It does not mean that she forgets
what has happened, but she can place it in perspective and not have it dominate her
whole life. She can also help the child and siblings with their own healing and
resolution.
In summary, by being aware of the range of responses in terms of belief and
protectiveness, child welfare workers can contribute to better outcomes for children.
While the research on maternal responsiveness is inconclusive, one thing is clear: a
supportive parent is associated with a better outcome for children. For this reason, a
nonjudgmental and empathic approach during the early stages of investigation and
intervention may be more effective than confrontation. Normalizing a parent’s denial or
shock and helping her to understand her response, rather than labeling her as “nonprotective” or “uncooperative,” can be an effective engagement strategy.
Trainee Content for Day 1, Segment 9
Myths & Research about Sexual Offenders5
There are commonly held beliefs about sexual offenders that are actually myths. Since
the 1970s, empirical data from various sources (research through the National Institutes
of Mental Health, records from Great Britain’s prisons and studies in outpatient clinics in
Great Britain and the USA) has improved our knowledge about sexual offending and
undermines these myths (Abel, Mittleman, Cunningham-Rather, Rouleau, & Murphy,
1987; Abel & Harlow, 2001).
1. Molesters usually have a particular type of victim they look for and are probably
not dangerous to children who don’t fit the profile (e.g., only molest boys, only
young girls, etc.).
In the 1970s, Gene Abel, MD and colleagues collected extensive data on 533 convicted
sex offenders in their Atlanta and New York clinics. These men received immunity from
prosecution and their names and information were sealed. Even with these protections,
the belief is that they underreported their offenses. Nonetheless, the findings from this
landmark study were astonishing:

62.5% of men who had molested a male had also molested a female.

23% of men who molested a female had also molested a male.

Of men who were convicted for molesting adolescents, 100% admitted to molesting
adolescents, 68% admitted to also molesting children, and 45% had also raped adults.

Of men who were convicted for raping adults, 100% admitted to raping adults, 49%
admitted to also molesting children, and 39% had also molested adolescents.

Of men who were convicted for molesting children, 100% admitted to molesting
children, 43% admitted to also molesting adolescents, and 34% had also raped adults
(Abel, et al., 1987).
A study from the British Penal System also found a very high degree of crossover in both
gender and age. For example, when the initial victim was a male child, 1 out of 3 men
who were subsequently rearrested victimized a female; when the initial victim was a
female, one-fifth was rearrested for a molest of a male child (Thornton, 2000).
5
The material on sexual offenders has been in part provided Miriam Wolf (Child Sexual
Abuse) and Niki Delson (www.delko.net).
Abel & Harlow (2001) later conducted a larger study with a sample of 3,952 admitted
child molesters and found:
 Of the pedophiles who molest girls, 21% also molest boys. Of the pedophiles who
molest boys, 53% also molest girls.

Male molesters whose preference is for adolescent males (14-17 years old),
“ephebophiles”, frequently become involved with other children. A study of over 600
male ephebophiles found that slightly over 50% also had a history of molesting boys
under age 14. In addition, over 28% had molested girls under age 14, and 20% had
molested girls 14 to 17 years of age.
2. There is a typical “offender profile.”
The Abel & Harlow Child Molestation Prevention Study (2001) highlights the fact there
is no typical offender profile and that child molesters look the same as everyone else.
(Note: Due to small sample size, all females’ data was removed from survey as was the
data for those who molested adolescents above the age of 13. See supplemental handouts
for more information on female perpetrators)
Comparison with Men in the U.S. Population:
Demographics (Admitted child molesters N = 3,952, Ages: 18 to 95, average age 38.5)
U. S. Males
Admitted Child
Molesters
Married or formerly
married
Some college or higher
education
High school graduate
73%
77%
49%
46%
32%
30%
Working
64%
65%
Religious
93%
93%
Ethnicity (2% of the study sample reported they were from none of the represented ethnicities)
U. S. Males
Admitted Child
Molesters
Caucasian
72%
79%
Hispanic/Latin American
11%
9%
African-American
12%
6%
Asian
4%
1%
American Indian
1%
3%
3. Because it is a family problem, incest offenders do not present much danger
outside their families.
From the Abel, et al (1987) study:
 65.8% of men who committed sex offenses inside of their families had also
committed sex offenses outside of their families.
From the Abel & Harlow (2001) study:
 68% reported they had molested a child in their family. (The 68% is based on
individual men, while each individual man may have molested one child or several
children who were in different family relationships with them.)
o 19% reported molesting a biological child
o 30% reported molesting a stepchild, adopted child (3.3%), or foster child (1.3%)
o 18% reported molesting nieces or nephews
o 5% reported molesting grandchildren
o 12% of perpetrators as teenagers, molested a much younger brother or sister
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40% reported molesting the children of their friends or neighbors.
o Nearly 24% of the men who were molesting children in their own family were
also molesting the children of friends and neighbors
o 5% said they had molested “a child left in my care by an organization”
4. Most sexual offenders perpetrate sexual abuse and rape because they were
victims of sexual abuse and are acting out what was done to them.
For many years, there has been an idea of a “victim-to-victimizer” cycle; that sexual
abuse as a child is a powerful risk factor for becoming a sexual offender. However, this
conclusion is not supported by research. Although not entirely without foundation
(somewhere between 20-30% of adult, male offenders do have a sexual abuse history),
most sexual offenders do not have sexual abuse histories. The “victim-to-victimizer”
theory was initially borrowed from physical abuse, where there is a stronger cycle
connection between childhood experiences and adult perpetrator behavior. The notion
was also supported by early retrospective self-report data from incarcerated, adult sex
offenders. This population has some motivation to exaggerate or lie about their abuse
histories, as people may look at their offenses more “kindly” if they are also “victims”.
Studies which attempted to verify these self-reports using polygraphs have demonstrated
that self-reports of victimization are exaggerated.
The rate does appear to be higher for children with sexual behavior problems. However,
most children who were sexually victimized never perpetrate against others. So,
while a sexual abuse history is a factor in individual cases, it does not seem to be
sufficient as a general explanation about why people sexually offend. The causes are
more complex. Research does point to links with childhood histories of physical abuse or
neglect and witnessing domestic violence, as well as other pathways that are similar to
other kinds of violent offending, such as early behavior/conduct problems, delinquency,
alcohol/drug use (Chaffin, Letourneau, & Silovsky, 2002).
Conclusions
There have been many classifications proposed to help categorize and understand the
motivations of offenders and predict recidivism (Cohen, Groth, & Siegel, 1978; Lanning,
2001). Typologies such as “fixated/regressed” and “situational/preferential” were
proposed. While important contributions to the literature, it has become clear that child
molesters are a very heterogeneous group, with different motivations for offending and a
need for varied treatment methodologies. The conclusions we can make are:
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There is no single “child molester personality profile.”
Child molestation is usually not an isolated incident; by the time it is discovered, the
pattern is often chronic.
Most offenders are reluctant to admit offenses/deviances other than that for which
they have been caught, but when given immunity, many molesters report victims into
the dozens or hundreds.
Offenders commonly use tactics of manipulation, deception, and denial to seduce
children and to convince others of their innocence.
We cannot assume that children who do not fit the molester’s “victim profile” are not
at risk; there is significant crossover among age, gender, and intra- and extra-familial
victims.
Trainee Content for Day 2, Segment 13
Treatment Issues
Treatment of the Child Victim6
It is not known if all children need treatment following sexual abuse. As discussed above
in the section on child victims, a significant number of children may not display
symptoms at the time of abuse. When children do display symptoms, the literature is
conflicting about whether and how quickly symptoms subside, with or without therapy.
There is great diversity in individual victim characteristics (see above section on
mediating factors). Some children will show improvement without therapy, some after
short-term (10–16 sessions), some only after longer-term therapy, and some may benefit
from “crisis-intervention” that consists of anticipatory guidance about recognizing and
responding to problems in the future.
While there is no available “formula” to determine whether and how long children
should be in treatment, every child and teenager who is a victim of sexual abuse
should be assessed by a qualified professional to determine their mental health
status and needs. Such evaluation should consider the possibility that some children
engage in maladaptive avoidant behaviors as well as the fact that few children or
teenagers will self-refer for treatment. (Note: In California, minors age 12 and older are
legally allowed to self-refer for the purposes of treatment for sexual assault. —Cal. Fam.
Code § 6924.)
The Mental Health Care for Child Crime Victims: Standards of Care Task Force
Guidelines published by the California Victims of Crime Program notes that an
appropriate child treatment plan should do the following:
 Take into account a child’s developmental status;
 Specify treatment goals that are achievable and that address the presenting
problems;
 Employ methods that have empirical support or the support of extensive expert
opinion in peer review publications;
 Include parents or caregivers in the treatment plan in a meaningful way;
 Include consultation with other adults who may have a significant role in the
child’s well being, e.g., teachers or healthcare providers;
6
Parts of this section were adapted by Miriam Wolf, LCSW, from Winterstein, M., &
Scribner, S. (Eds.) (2001). Mental health care for child crime victims: Standards of Care
Task Force guidelines. Sacramento, CA: Victims of Crime Program, California Victim
Compensation and Government Claims Board. Used with permission of, and thanks to,
Michele Winterstein, Ph.D.

Assume that if any gains made in the therapy hour are to survive and generalize,
the child must be living in a safe environment, free from abuse.
While there are different modalities of providing therapy (individual, group, play therapy,
etc.), many child victims can benefit from trauma-focused, or abuse-specific, treatment.
The treatment goal is successful emotional and cognitive processing of the event.
Education is provided to the child and family by the therapist. If disturbing events can be
described, and the responses to them understood, then out-of-proportion attributions for
the event and the abuse-related coping responses can be contained, avoiding the
development of more serious consequences over time.
Frequently cited goals of therapy with sexually abused children include:
 Providing a safe release of feelings, both positive and negative, about the abuse
experience;
 Providing relief from symptoms and behaviors that are interfering with the child’s
functioning and making connections between the behaviors and the abuse
experience;
 Helping to correct cognitive distortions (how thinking has been affected by the
abuse, misunderstandings, misattributions of blame, etc.);
 Addressing any developmental interruptions (assisting the child or adolescent in
redoing missed or distorted tasks and encouraging growth)
 Rebuilding trust in oneself and in others;
 Developing a sense of perspective and distance regarding the trauma, and hopes
for the future;
 Education and support about age-appropriate aspects of sexuality.
Longer-term therapy may also address the longer-term effects of abuse and associated
behaviors (discussed above in the section on victim dynamics, effects, and mitigating
factors). Because intrafamilial abuse occurs within the context of a family, all of the
family relationships are affected, first by the abuse itself and then by changes in the
family system that occur with intervention. The relationships between the victim and the
offender, non-offending parent and sibling(s) are usually complex and affects children in
multiple aspects of their emotional and social lives. While there are emotional impacts
such as guilt, ambivalence, fear, and anger toward the offender, or feelings that the nonoffending parent failed to protect them, there may also be issues associated with losses
such as removal from the family home, loss of relationships with family and friends, and
the challenge of adjusting to life with relatives, foster parents, or residential placement.
Treatment may also address these areas.
The child’s therapist may also coordinate and monitor the timing and advent of visitation,
dyadic and family therapy, and reunification, if planned (see section on visitation and
reunification, above). It is recommended that each family member (child victims,
siblings, and non-offending parents) have access to their own individual or group therapy.
Dyadic and family therapy, often concurrent with individual or group therapy, can
accelerate progress for many children and families. Managing the intense feelings that
can be generated by that therapy and visitation are key areas for the child’s therapist in
cases of intrafamilial sexual abuse. Reunification therapy is quite complicated and
requires specialized training. CPS workers should be sure that the child’s therapist has
expertise in this area.
Treatment of Adolescents
A note about treatment needs of adolescents: Like younger victims, not all adolescents
will need psychological treatment. Developmental issues, however, often get in the way
of an accurate assessment of treatment needs. The impact of abuse can vary depending
on onset and duration of abuse—whether it began in childhood and continued, worsened
in adolescence, or began in adolescence. Some adolescents view treatment as intrusive
and a challenge to their emerging autonomy. Many work very hard at avoiding dealing
with the experience only to have symptoms/effects emerge at a later time. Still others
view treatment as a “punishment” and express anger that no one else (non-offending
parent or offender) “has” to go. Additionally, some adolescents view the relationship in
question as consensual and are angry at others’ perception of it as abusive. It is safe to
say that many adolescents will be reluctant to enter therapy for these and other reasons.
Just as in other areas of providing guidance and limit-setting to teens, this may be an area
where their reluctance to do something should not always be accepted at face value.
Developing a cadre of therapists with demonstrated success in engaging and working
with adolescents to refer to is important for CPS workers.
Treatment of Siblings
Just as victims should be assessed for treatment needs and goals, so should siblings.
Siblings may have their own as-yet-undisclosed victimization/trauma history as well as
emotional responses to what has transpired in the family. Complex feelings may include
anger/blame (at the victim, other family members, the situation), guilt, fear, jealousy as a
result of observing the favored status of the victim, helplessness and powerlessness in the
face of a perceived inability to protect the victim. These issues should be addressed in the
therapy of the sibling in order to develop or restore a healthy, mutually respectful and
protective relationship between the victim and his or her siblings.
Treatment of the Non-Offending Parent
As discussed above, the literature demonstrates that non-offending parents frequently
experience significant distress following a disclosure of sexual abuse. The literature also
confirms that support/protection from non-offending parents is associated with improved
emotional and behavioral adjustment and healing in the child victim. For these reasons,
non-offending parents should also be referred for a mental health assessment. Because
their symptoms and coping abilities will vary during this tumultuous period, assessments
may need to be conducted at different points in the life of a case.
Foci of treatment often include:
 Support/empathy for distress symptoms;
 Psycho-education about sexuality and dynamics/effects of sexual abuse;
 The offending cycle/how abuse happens;
 Reducing denial and minimization;
 Addressing feelings of betrayal and violation by the offender;
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Addressing effects of prior victimization, if any;
Increasing capacity for safety and protection;
General parenting education and support.
Offender Treatment
Most offender treatment programs use a combination of cognitive-behavioral treatment
and relapse prevention techniques. Modalities include both individual and group therapy
and may include victimization awareness and empathy training, cognitive restructuring,
learning about the sexual abuse cycle, relapse prevention planning, anger management
and assertiveness training, social and interpersonal skills development, substance abuse
treatment, and changing deviant sexual arousal patterns. Pharmacological interventions
may also be used.
CPS workers should ensure that any treatment provider is experienced working with a
sex offender population. Treatment providers should be able to mention the instruments
they use in evaluation and treatment and the professional organizations they belong to
(ATSA—Association for the Treatment of Sexual Offenders and CCOSO
http://www.ccoso.org —California Coalition on Sexual Offending, etc.).
Treatment in Los Angeles County
In Los Angeles County, the Department of Children and Family Services has what seems
to be a unique approach to intrafamilial child sexual abuse. The agency has two units that
are staffed by line staff who are licensed, that provide counseling to families impacted by
intrafamilial child sexual abuse.
The mission of these two counseling programs is to specifically work with these families
who present high levels of risk related to the perpetrator's continued access (intent to
silence or minimize the disclosure) and the non-offending parent’s ambivalent response
to the child victim. These two crises limit the family members from benefiting from
treatment that is short term and growing in availability in the community.
This is especially evident now due to the emergence of Trauma-Focused Cognitive
Behavioral Treatment (TFCBT), which is strongly recommended as a treatment approach
that is highly effective in mediating child trauma. The two crises noted above limit
individual family members from benefiting from TFCBT.
The Los Angeles County Department of Children and Family Services supports the
Sexual Abuse Treatment Program so long as the program prepares clients to benefit from
TFCBT by reducing the impact of these crises. The agency benefits by keeping children
in the home of the parent more often than without the service, by returning children who
are placed in out-of-home care faster, and by stopping the cycle of abuse referrals. These
represent Title IV-E Waiver cost savings.
The point is that in treatment, the crises of intra-familial child sexual abuse regarding
perpetrator access, and non-offending parent support must be addressed prior to referring
the client family to TFCBT. In the video clip “Johnny’s Story,” the use of TFCBT could
have helped Johnny and his family resolve the trauma after short-term treatment. It is the
time spent resolving the crises of intrafamilial child sexual abuse that CSWs often must
focus on in case management. CSWs also work with specially trained therapists as part
of this process.
Workers should check with their counties and supervisors about treatment in their locale.
Summary of Treatment Issues
Guiding principles for treating intrafamilial sexual abuse should include the use of
consultation, collaboration with adjunct services and external systems, and coordination
among treatment providers. If these guidelines are incorporated into the therapy process
and the family is motivated to pursue treatment, the prognosis for a successful outcome is
good.
The California Victims of Crime Program’s Standards of Care Task Force identified
several general principles in the treatment of intrafamilial abuse. These are as follows:
 The safety of the child requires a thorough initial assessment and continuing
vigilance regarding risk. The child’s safety is paramount.
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Treatment is best carried out with multiple therapists. This requires coordination,
collaboration, and consultation among several treatment providers.
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All family members should have access to therapy, including child victims,
siblings, non-offending parents, and offenders.
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The therapist must be able to navigate through multiple systems, including law
enforcement, the courts, and child welfare services.
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Children and families often need advocacy as they interact with other agencies
and systems.
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Family therapy is an essential component of a successful treatment plan for
intrafamilial abuse, although who to include in sessions and the timing of sessions
requires considerable clinical judgment.
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Group therapy is often beneficial in intrafamilial abuse cases to help reduce
isolation, decrease denial, normalize traumatic events, and to encourage peer
group empathy and emotional support.
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When parenting ability is impaired (for example, by substance abuse or mental
illness), treatment must include the use of adjunct and consultation services and
referral of the client to appropriate resources.
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Treatment plans may require strategies for contact between the victim and
offender, such as conjoint therapy or monitored visitation.