Search

Online child sexual abuse material (CSAM) is a growing problem. Prevention charities, such as Stop It Now! UK, use online messaging to dissuade users from viewing CSAM and to encourage them to consider anonymous therapeutic interventions. This experiment used a honeypot website that purported to contain barely legal pornography, which we treated as a proxy for CSAM. We examined whether warnings would dissuade males (18-30 years) from visiting the website. Participants (n = 474) who attempted to access the site were randomly allocated to one of four conditions. The control group went straight to the landing page (control; n = 100). The experimental groups encountered different warning messages: deterrence-themed with an image (D3; n = 117); therapeutic-themed (T1; n = 120); and therapeutic-themed with an image (T3; n = 137). We measured the click through to the site. Three quarters of the control group attempted to enter the pornography site, compared with 35 % to 47 % of the experimental groups. All messages were effective: D3 (odds ratio [OR] = 5.02), T1 (OR = 4.06) and T2 (OR = 3.05). Images did not enhance warning effectiveness. We argue that therapeutic and deterrent warnings are useful for CSAM-prevention., Competing Interests: Declaration of competing interest The authors have no competing interests to declare., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

This study examined the role of character evidence and other issues in criminal appeals of child sexual abuse (CSA) convictions. Character evidence includes uncharged acts and character witnesses who testify to another's reputation or opinion and is offered to prove an individual's propensities. Examining 168 appellate court opinions reviewing CSA convictions between 2005 and 2015 in Maricopa County, Arizona, we found that when specific types of evidence were at issue, they were most often character evidence issues (49%). However, appellate courts virtually never reversed convictions ( n = 5), and when defendants did obtain relief, the reduction in charges or in sentences was minor. Of the small number of opinions that were published ( n = 4), all focused on character evidence, including the single case reviewed by the Arizona Supreme Court. However, close examination of the published cases suggested they effected only modest change., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Regardless of compliance to coercion by an alleged perpetrator, child maltreatment is abuse in any form. However, the extent to which coercion is described as an obligation (mandatory compliance) or permission (optional compliance) is legally relevant. The present investigation examined how attorneys question children about coercion and how children describe coercion in courtroom investigations of alleged child sexual abuse, and whether such language influences jurors' perceptions of children's testimony. Study 1 assessed 64 transcripts of children's testimonies and revealed that both attorneys and children use coercive language. Problematically, terms of permission were used when describing sexual abuse, potentially implying compliance was optional. Study 2 presented 160 adults with transcript excerpts, varied by coercive language (obligation or permission) and maltreatment type (sexual abuse or punishment). Coercive language influenced perceptions of coercion and whether the adult was to blame. Maltreatment type influenced perceptions of severity, credibility, and verdict. Overall, coercive language and maltreatment type influence perceptions of how the event unfolded., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: As digitalization has made it easier to produce, copy, and distribute child sexual exploitation material (CSEM), the possession and distribution of child sexual abuse images has become more widespread. Thus, the need to assess the risk of subsequent sex offenses - above all, sexual abuse of children by individuals who have been convicted of CSEM offenses - becomes more and more important., Objective: The main objective of this paper is to contribute to the understanding of the respective size of two groups of offenders: first, offenders who commit CSEM offenses without ever crossing the line to sexual abuse of children, and second, so-called crossover offenders, that is, individuals who commit CSEM offenses and engage in child sexual abuse. Identification of differences between these two groups facilitates analyzing the risk that someone convicted of a CSEM offense might in the future sexually assault children., Method: We used data from the German Federal Central Criminal Register (Bundeszentralregister), a data set that includes information about all persons convicted of any criminal offense, including "child pornography" offenses, by a court in Germany., Results: For persons convicted of CSEM offenses only, with no additional concurring sex offenses, the rate of subsequent convictions for child sexual abuse is very low (1.1 % after a six-year follow-up period, adult offenders). This risk is even lower if offenders are older than 30 years of age, and it is slightly higher for offenders with previous offense-specific convictions (i.e., previous sex offenses)., Conclusions: The mere existence of a conviction for a CSEM offense is not an indication that the convicted person poses a significant risk of committing child sexual abuse. To pinpoint such a risk more accurately, the following factors should be examined: the existence of offense-specific prior records, the presence of crossover-offending in the form of concurring offenses, and the age of the offender., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Within the US, children and adolescents who engage in sexually abusive behavior are often subjected to sex offender registration and notification requirements, which contribute to stigmatization and forfeiture of their civil rights without empirical basis (Lancaster, 2011; Pickett et al., 2023; Zilney & Zilney, 2009). To date, 39 states subject children with adjudicated sexual offenses to sex offender registration requirements, with most recent estimates revealing that approximately 200,000 youth have been placed on sex offender registries within the US and many are now on the registry as adults (Pickett et al., 2020). This severe response-by both members of the public and policymakers-toward children who engage in inappropriate sexual behavior is imposed upon children and adolescents with adjudicated sexual offenses in an effort to meet goals of reducing sexual violence and increasing community safety. Within the current discourse, we review the history of registration and notification practices for adolescents with sexual offenses, describe what registration and notification policies entail, and then present empirical and theoretical evidence of the harmful outcomes associated with implementation of registration and notification requirements for sexual offenses. Thus, the predominant aim of this discourse is to encourage thoughtful and critical examination of registration and notification policies and their iatrogenic impacts., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: States in the United States (US) have passed and enacted legislation for the purpose of preventing child sexual abuse (CSA) since 2000, but it is unknown whether these legislative policies reduce adult-perpetrated CSA., Objective: Review the literature from 2000 to 2023 to understand which US CSA prevention policies have been evaluated, the effectiveness of these policies, study populations, and barriers and facilitators associated with the implementation of CSA prevention policies., Methods: The study protocol was published prior to undertaking the review: PMC10603531. The review follows Joanna Briggs Institute methodology and is reported according to the PRISMA-ScR Checklist. We searched 27 databases, hand searched reference lists of included studies, and sent notice via listserv to other researchers in the field. Articles were included if the content focused on CSA prevention policies and the effects. No limits to methodology were applied. Methodological rigor was assessed., Results: 2209 potentially relevant articles were identified; 20 articles advanced to full-text review, three satisfied the inclusion criteria. Three eligible studies focused on CSA prevention education policies, while the other focused on mandated reporting policies. Effects of these policies were mixed in relation to CSA reporting and substantiation rates. No study considered child demographics., Conclusions: Despite decades of legislative action for CSA prevention across the US, only a few studies have assessed the effects of these policies. These findings highlight the need for additional research to ensure that CSA prevention policies such as CSA prevention education in schools and mandated reporting practices are working as intended., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

This article explores how South Australian judges use information about child sexual abuse (CSA) victimization history and its potentially traumatic impact, when sentencing adult defendants. Past research indicates that sentencing outcomes may significantly improve if judicial officers are "trauma-informed." "Trauma" is the distressing impact of adversity on an individual's social and emotional well-being. Drawing from a sample of 33 sentencing remarks within which judicial officers have identified defendants with histories of CSA, this article applies a trauma-informed practice framework to explore the degree to which the sentencing of these defendants may be trauma-informed. Finally, the paper discusses potential initiatives to better achieve community safety when sentencing people with trauma from CSA. The findings are highly transferable, given the parallels in the sentencing calculus across countries that have a Westminster system of law.

Attempts to address the threat of harm posed by perpetrators of child sexual abuse (CSA) have rightly increased in recent years, with well-known efforts such as operation NOTARISE resulting in 750 arrests; however, the cost of such operations is also high. Operation NOTARISE resulted in 24 suicides; the estimated economic and social cost of which has been estimated to be £34.8 million. [1] Perpetrators who view child sexual abuse materials (CSAM) are not only at higher risk of suicide than the general population, individuals diagnosed with a mental health disorder, and perpetrators of other violent and sexual crimes, [2-5] but they also appear to be at higher risk of suicide than perpetrators of CSA who engage directly in sexual acts with a child . [6-8] An in-depth understanding of the experiences of CSAM offenders is missing in the literature, but is required to understand how to mitigate the risk of suicide amongst this high risk group. This qualitative study investigates the experiences of CSAM perpetrators from the perspectives of law enforcement officers (n = 16), CSAM perpetrators themselves (n = 5), and help-line operators who have provided support to CSAM perpetrators through the Lucy Faithfull Foundation "Stop it now!" helpline (n = 6). Analysis was conducted separately for each dataset and in accordance with guidelines set out by Braun and Clark . [9] The focus of this paper is the six over-arching themes that were common across all datasets: (i) offender demographics; (ii) psychological impact of arrest; (iii) coping with the investigation; (iv) cognitive distortion; (v) shame and stigma; and (vi) professional support. Findings are discussed in the context of the challenges faced by law enforcement and healthcare professions when providing support to this high risk group, and eight key recommendations are made to reduce the risk of suicide., (Crown Copyright © 2021. Published by Elsevier Ltd. All rights reserved.)

Introduction: The last two decades have seen an exponential growth in the distribution and availability of child pornographic material on the Internet and social networks. The medical community is involved in assisting the investigating authorities in relation to estimating the age and sexual maturity of the alleged victims., Objective: To determine the efficacy of using Tanner stages as a method for esti mating chronological age in alleged child pornography cases based on published evidence., Material and Method: Systematic review study in PubMed and Scopus databases following PRISMA guideli nes. Articles describing the outcome of using Tanner stages to estimate chronological age in alleged child pornography cases were identified. For screening, those written in English or Spanish published from January 1, 2000, to April 30, 2020, were considered. The following data were extracted from the articles included: type of study; material and methods used; Tanner items examined; evaluators' characteristics; results; estimated chronological age versus real age; observer-dependent variations (bias); and conclusions., Results: Seven studies were included. Three were literature reviews and four were case studies with expert testimony and observer bias. This method is ineffective when the alleged victim, in both sexes, shows sexual maturation in Tanner stages 3-5. In stages 1-2, it may be useful to state that the victim is under 18 years old, but not to determine their chronological age., Conclusion: Scientific evidence discourages the use of Tanner stages to estimate the chronological age of the vic tim from images in alleged child pornography cases. Pediatricians, and other medical professionals, should avoid making a testimony that is not scientifically based.

Introduction: Prosecution of child sexual abuse (CSA) cases provides safety for communities and justice for victims. Prosecutorial decisions are multifactorial and include the presence of a structured coordinated community response to outcries and access to skilled healthcare providers. This study examines the impact forensic nurse sexual assault examinations (SAEs) have on prosecution in a population of children seen at a child advocacy center (CAC)., Methods: The authors examined case data from 553 cases of reported CSA, seen by a forensic nurse in a CAC., Results: Statistical analysis focused on prosecution decisions with and without SAE, with and without physical findings. Logistic regression determined prosecution occurred more often when SAE had been conducted (p = 0.026, OR = 1.732, 95% CI [1.068, 2.808]), regardless of examination findings., Limitations: The limitations include a single location for data and the multifactorial reasons for prosecution of cases., Discussion: The multifactorial elements contributing to prosecutorial decisions are diverse. The formalized approaches in CACs historically show increased prosecution. Teasing out the impact of an SAE in a CAC may be reflective of positive CAC approaches. Regardless, a statistically significant finding of association uniquely with the SAE, with or without findings, implies more studies are needed to support the role of the forensic nurse in successful prosecutions of CSA cases., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 International Association of Forensic Nurses.)

Objective: To explore the characteristics of older adult first-time sex offenders (who offended for the first time at the age of 65 years or above)., Design: The authors retrieved and analyzed data from the publicly available Missouri sex offender registry database up to December 2018 and the Missouri public case management system website., Participants: Registered older (≥65 years) sex offenders in the state of Missouri, United States., Measurements: Sociodemographic characteristics of the offender, offense type(s), offense, and conviction dates; age and sex of the victim(s); and case disposition information (whether the trial was waived or not and what were the sentences imposed)., Results: One hundred and ninety-four older adult sex offenders all males were identified, of which 172 were first-time offenders. The majority were white; the median age of offense was 68.6 years old. One hundred and thirty-nine (80.8%) first-time offenders were convicted strictly of non-pornography offenses, with prepubescent girls the predominant victim pool. The most prevalent charge in this subgroup was Child Molestation, First Degree (36.5%). Twenty-eight (16.3%) offenders were convicted strictly of pornography offenses, the most prevalent one being Possession of Child Pornography (96.6%). The recidivism rate among first-time offenders was close to 1%., Conclusion: A substantial proportion of older registered sex offenders are first-time sex offenders and most of them have underage victims. Although the offense and recidivism rates seem to be low, future longitudinal studies should focus on the predictors of sexual offending in the older population, in order to design targeted preventive measures, risk assessment, and treatment options., (Copyright © 2020 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.)

Introduction: Child sexual abuse is a disturbing reality and a major public health problem. Indeed, it is a subject that has long been treated as taboo, with dramatic consequences on physical and mental health as well as on social wellbeing of the victims. The purpose of this study was to highlight the epidemiological and clinical features as well as the legal aspects of child sexual abuse., Methods: we conducted a retrospective descriptive study at the psychiatric outpatient service of the University Hospital of Monastir over a period of 12 years and 6 months. All children younger than 18 years diagnosed with suspected or confirmed sexual assault were included., Results: a total of 93 children, victims of sexual abuse were enrolled. The average age of patients was 10 years, with a standard deviation of 3.9 years. Sex-ratio M/F was 0.9. The most common sexual contact was touching (47,3% of cases). The majority of abusers were male (93,5%). In more than half of the cases (53,8%) they were relatives of the child and in 28% of cases intra-familial abuse was reported. Initial psychiatric assessment showed mental disorders in 70% of cases., Conclusion: sexual abuse is a very broad field of violence which varies widely in nature and intensity. Although, in some types of sexual abuse occasionally there is a lack of physical traces, the emotional and psychological impact is ubiquitous and characterized by numerous clinical manifestations., Competing Interests: Les auteurs ne déclarent aucun conflit d´intérêts., (Copyright: Rim Ben Soussia et al.)

The issue before the New Jersey Supreme Court in the Frye hearing New Jersey v. J.L.G. (2018) was whether the scientific community agreed that Summit's (1983) Child Sexual Abuse Accommodation Syndrome rested on a firm scientific foundation. Lyon et al. (this issue) critique our approach to describing child sexual abuse disclosure, which involved extrapolating rates from children who came to the attention of authorities. Lyon et al. claim that our conclusions are marred by sampling biases resulting from what they term the ground truth problem, suspicion bias and substantiation bias. The points Lyon et al. claim we "fell victim to" were the very points we acknowledge are inherent difficulties in estimating the extent to which children will come forward to tell others about sexual maltreatment. Lyon et al. offer an alternative solution to the inherent difficulties in studying a difficult-to-identify population, relying in large part on 21 papers published mostly in the 1960s and 1970s. We argue that the method they propose has more flaws than the one it is intended to replace. Points of agreement and disagreement, along with suggestions for future research, are discussed. Moving forward, we argue that studies are needed that embrace both validity and generalizability in order to foster data-driven theories rather than invoking the intuitive suppositions of Summit's (1983) syndromal evidence., (© 2020 John Wiley & Sons Ltd.)

Since its adoption by the United Nations in November 1989, the Convention on the Rights of the Child (CRC) has become the most universally ratified human rights treaty in history; presently only the United States has not ratified it. The CRC articulates children's human rights and notably includes freedom from sexual abuse and exploitation. Yet thirty years after the Convention was adopted, child sexual abuse and exploitation (CSA/E) remain serious, persistent, and evolving global issues. This overview both describes the current state of research on child sexual abuse and exploitation and evaluates the CRC's legacy in terms of State-level responses to CSA/E. Points of agreement and disagreement over what constitutes CSA/E and how widespread it is are explored. Also presented are the contexts in which CSA/E takes place, and factors associated with children's risk of being sexually abused or exploited. Emerging issues in these areas are the internet and children's use of it, as children may now become subject to abuse or exploitation even when physically alone. The second part of the paper addresses the CRC's influence on States' domestic legislation and States' responses to CSA/E more broadly. Gaps in efforts to monitor and report on the CRC's implementation with respect to its impact on CSA/E are described. The discussion offers guidance for future efforts to research and respond to child sexual abuse and exploitation, and in particular the ongoing need for support to survivors beyond the legal response paradigm., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Successful prosecution in child sexual abuse (CSA) cases is an essential purpose of law enforcement agencies to ensure accountability of perpetrators and children's safety. However, research has shown that legal prosecution of CSA cases is a highly complex endeavor resulting in only a limited percentage of cases being prosecuted and ultimately proven in court. Most attrition occurs at the stage of the police investigation. The current study is the first study of CSA prosecution in an Asian country. We aimed to identify factors, which contribute to Indonesian CSA cases prosecution. We examined police files of CSA cases ( N = 179) from three police units in greater Jakarta. We found that only 32% ( n = 58) of cases were prosecuted. The following factors increased the odds of prosecution: victim being threatened, the suspect confessed, medical examination report being present, duration of investigations between one to 2 months, and the case being charged under the Child Protection Law. These findings (threat, suspect confession, and the presence of a medical examination report) correspond to previous studies in other jurisdictions.

Child pornography involves the realisation of deviant fantasies with very specific characteristics with regard to its content and use and therefore the legal action needed to deal with it. The internet has facilitated its dissemination and access and complicates the issue but we need to be able to identify and track people who use illegal pornography. This paper is based on a review of the literature and presents some criminological characteristics of child pornography on the internet.

Child sexual abuse (CSA) requires multidisciplinary approach by forensic, social, and medical services, thus Child Advocacy Centers (CACs) have been established to evaluate CSA cases in Turkey. At CACs the social needs of children are assessed by social workers. Protective and supportive injunctions (PSIs) are considered at each step of evaluation and are proposed to child courts. This study aimed to evaluate PSIs at a local CAC, which is one of the leading CACs in Turkey. The study group consisted of children and adolescents exposed to CSA admitted to Izmir CAC between April 2014 and April 2015. Socio-demographic characteristics, social investigation reports, psychiatric reports, and proposed PSIs were evaluated. The rate of social investigation necessity was 28.3% (n = 113), and the rate of being proposed for at least one PSI was 24.3% (n = 97). The most common proposed injunctions were maintenance care injunctions (n = 47; 48%) and counseling injunctions (n = 46; 47%). The rate of proposed PSIs was significantly higher in adolescents, incest cases and abuse types including penetration than in the other groups. This is the first study to evaluate PSIs in the child protection system. Our results provide data about the risk groups that need PSIs among the victims of CSA cases.

Girls in India continue to be sexually abused/exploited under the veil of traditional practices such as Devadasi dedication despite the existence of legislation meant to protect them from child sexual abuse. This study recounts the experiences of 30 Devadasi girls who were dedicated, initiated into sexual activity, and involved in commercial sexual activity as children. It underscores the need to address this practice as a criminal offense to be prosecuted under the legislation. Efforts must be made to explicitly connect Devadasi dedication and child sexual abuse in the minds of the public, law enforcement agencies and government officials.

Background: Despite being a complex phenomenon with potentially significant short- and long-term consequences for all involved including siblings, parents and the family as a whole, sibling sexual abuse (SSA) has not received sufficient empirical and clinical attention. Practitioners are often left to cope without appropriate guidance., Objective: This study aimed to compare staff perspectives and experiences of working with sibling sexual abuse cases across two Child Advocacy Centers (CACs) within different countries and different cultural and legal contexts., Participants and Setting: Participants were staff members from two Child Advocacy Centers: one in Jerusalem, Israel, and the other in Montgomery County, Pennsylvania, United States of America., Methods: This qualitative cross-cultural comparative study analyzes staff experiences of sibling sexual abuse cases based upon 14 focus groups, in Jerusalem (N = 7) and Montgomery County (N = 7)., Results: Findings reveal that both CACs focused on parents, the parents' negative emotional responses to SSA, and the impossible nature of their predicament. The Montgomery County CAC tended to emphasize the needs of the victim while being attuned to the legal proceedings, whereas the Jerusalem CAC emphasized supportive therapeutic responses for the whole family., Conclusions: The differences across the two Child Advocacy Centers are related to the different legal and cultural contexts of the two CACs and underscore the need to review what may be the most appropriate policy and practice response to SSA that does not itself cause further harm., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Sibling sexual abuse (SSA) is a widespread form of intrafamilial child sexual abuse frequently regarded as play or normal sexual behavior, and therefore highly underreported. Israeli law allows Child Protection Officers (CPOs) to suspend police intervention after the disclosure of SSA, and refer the family to therapy, by applying to an "exemption committee.", Objective: This study will examine the characteristics of cases referred to the exemption committee or legal procedure and the justifications provided by CPOs to support the decisions., Participants and Setting: The study was based on 40 family cases referred to the Child Advocacy Center in Jerusalem: twenty cases were referred to an exemption committee and the rest to legal procedure., Method: Qualitative document analysis conducted on the two groups of cases (N = 40). Files were then analyzed using the thematic analysis approach., Results: During the decision-making process, CPOs assess each of the cases in a broad and holistic manner, basing their decisions on various contextual factors, including the characteristics of the survivor, the perpetrator, the parents and other siblings, and the types of sexual acts involved., Conclusions: This comprehensive approach to understanding and handling the complex family story and nature of SSA underscores the need to address SSA and subsequent interventions - legal or therapeutic - not exclusively in terms of quantifiable criteria, but also in terms of a crisis involving the relationships in the entire family, past and future course of treatment, and the perceptions of family members involved., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

The separation of rural families in China has resulted in a large number of "left-behind" children, who are frequently subjected to sexual abuse. Failing and insufficient tutelage owing to the migration of parents into cities and the distinctive rural living environment (e.g. drab and enclosed habitats) are the major causes of the high incidence of sexual abuse against left-behind children. We have applied the concept of "ritualized law" ( lihua de fa ) to delineate the powerless position of the state legal system vis-á-vis the sexual assaults committed against left-behind children in rural China. Pervasive and ingrained traditional customs and rituals, and the intermediary relationships between familiar people, have restricted the reach of the judicial system in rural areas. Moreover, deeply rooted traditional beliefs and the primacy of interpersonal (and inter-familiar) harmony over legal and formal institutions have weakened the legal system and, in many cases, allowed sexual offenders to avoid prosecution.

As children's testimonies of child sexual abuse (CSA) often lack concrete evidence to corroborate a child's claims, attorneys devote a substantial amount of time to establishing a child as credible during the course of a trial. Examining 134 CSA victim testimonies for children aged 5-17 ( M = 12.48, SD = 3.34; 90% female), we explored how attorneys assess child credibility through specifically targeting children's suggestibility/honesty, plausibility, and consistency. Results revealed that while prosecutors examine plausibility more often to establish credibility, defense attorneys focus their assessments on suggestibility/honesty and potential inconsistency. However, both attorneys asked many more questions about children's consistency than any other area of potential credibility. Furthermore, while prosecutors ask proportionally more credibility-challenging questions of older children, the defense do not. These results suggest that prosecutors may be missing an opportunity to establish children as honest and consistent and elucidate a need to train attorneys on the implications of children's inconsistencies, suggestibility, and plausible abuse dynamics.

Human trafficking and child sex trafficking and sexual exploitation in particular are global public health issues with widespread, lasting impacts on children, families, and communities. Traditionally, human trafficking has been treated as a law enforcement problem with an emphasis on the arrest and prosecution of traffickers. However, use of a public health approach focuses efforts on those impacted by exploitation: trafficked persons, their families, and the population at large. It promotes strategies to build a solid scientific evidence base that allows development, implementation, and evaluation of prevention and intervention efforts, informs policy and program development, and guides international efforts at eradication. This article uses the public health approach to address human trafficking, with a focus on child sex trafficking and exploitation. Recommendations are made for public health professionals to contribute to antitrafficking efforts globally.

This invited article is one of several comprising part of a special issue of Child Abuse and Neglect focused on child trafficking and health. The purpose of each invited article is to describe a specific program serving trafficking children. Featuring these programs is intended to raise awareness of innovative counter-trafficking strategies emerging worldwide and facilitate collaboration on program development and outcomes research. This article describes the Law Enforcement First Responder Protocol, which trained law enforcement to recognize youth engaged in sex work as survivors of commercial sexual exploitation, rather than as "prostitutes", and to connect these survivors immediately with social services, advocates, timely medical care and ongoing follow-up., Competing Interests: Declaration of Competing Interest The National Center for Youth Law’s participation in the development, implementation and monitoring of the First Responder Protocol was funded primarily through a contract with the Los Angeles County Probation Department, with additional funding provided by the NoVo Foundation. All of the authors were involved in this work as part of their daily work responsibilities, and none of them received any extra remuneration for this work., (Copyright © 2019. Published by Elsevier Ltd.)

This invited article is one of several comprising part of a special issue of Child Abuse and Neglect focused on child trafficking and health. The purpose of each invited article is to describe a specific program serving trafficked children. Featuring these programs is intended to raise awareness of innovative counter-trafficking strategies emerging worldwide and facilitate collaboration on program development and outcomes research. This article describes the Minnesota Runaway Intervention Program (RIP), a Minneapolis-St. Paul based program dedicated to supporting youth aged 12-17 who have run away and experienced sexual violence, including sexual assault and exploitation. It is a comprehensive, health care focused intervention, embedded within a hospital-based Child Advocacy Center. RIP is developed and led by nurse practitioners who provide services tailored to participants' diverse needs, including health care, case management services, and a therapeutic empowerment group., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

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

Purpose of Review: Sextortion is defined as the act of coercing people into sending explicit images of themselves and subsequently blackmailing victims with the public release of said images. Prosecutions of sextortion cases involving minors have increased almost two-fold in the past 5 years. The purpose of this review is to explore the literature regarding the behavior of both victims and perpetrators, the effects on victims, and the support resources available for clinicians, victims, and parents., Recent Findings: Sextortion begins as an unassuming request for personal pictures and quickly escalates. Minors targeted by predators fear both punishment by guardians and the social consequences that follow the release of their explicit pictures. This cycle of victimization endangers minors and may lead to mental health problems, such as anxiety and depression. Recently, sextortion cases have risen to the forefront of national attention through the mainstream media with celebrities revealed as both perpetrators and victims. This higher visibility of sextortion highlights the importance of reviewing recent research regarding minors and their online behavior and the tactics of perpetrators., Summary: Sextortion, an extreme form of cyber abuse, endangers minors and may lead to anxiety and depression. Pediatricians should be familiar with the concept of sextortion and discuss its dangers and available resources with parents and minors.

This study of attrition compares the prosecution of child sexual offenses reported while the complainant was still a child with those in which the report was delayed into adulthood; it also compares matters involving adult and young (under 18 years) suspects/defendants. It is based on an analysis of police and court administrative data in New South Wales, Australia over a 14-year period (2003-2016). Only one in five (21.6%) proceeded beyond the investigation stage. Criminal proceedings were more likely to commence when the alleged victim was 7-12 years old at the time of the incident, when the suspect was an adult and at least 10 years older than the victim, and also when the report to police was made when the victim was an adult. Just over half (55.5%) of the matters finalized in court resulted in a conviction. Cases in the higher courts were less likely to be dismissed and more likely to feature guilty pleas and convictions at trial than cases in the lower courts. The overall estimate is that only 12% of offenses reported to police resulted in a conviction, at a relatively stable rate over 14 years. These findings are consistent with those of comparable studies.

This invited article is one of several comprising part of a special issue of Child Abuse and Neglect focused on child trafficking and health. The purpose of each invited article is to describe a specific program serving trafficked children. Featuring these programs is intended to raise awareness of innovative counter-trafficking strategies emerging worldwide and facilitate collaboration on program development and outcomes research. This article describes Project Intersect, a program of mental health services and behavioral health professional training designed to address trauma-related psychological and behavioral problems experienced by adolescent survivors of commercial sexual exploitation and trafficking. The project is led by the Georgia Center for Child Advocacy in Atlanta, GA, USA. The primary goal of the program is to build a cadre of behavioral health specialists with skills to implement trauma-focused cognitive behavioral therapy to address the unique needs of trafficked/exploited youth. This involves intensive initial training, follow-up consultation, technical support, and program evaluation., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Child sexual abuse (CSA) is a major global health challenge. Extant literature shows that CSA is prevalent in Kenya. As a signatory of the United Nations Convention on the Rights of the Child and the African Charter on the Rights and Welfare of the Child, the Kenyan government is mandated to ensure that children are protected from sexual abuse through sound laws and policies. This paper reviews existing laws and policies on CSA and highlights their strengths and weaknesses. Our findings indicate that laws on child protection exist and are protective to a large extent, as harsh penalties are outlined for sexual offences. Survivors of CSA are entitled to free legal and medical services. However, there are no reparations offered to survivors in criminal proceedings. Moreover, there is no legislation on age-appropriate comprehensive sexuality education which plays an important role in cultivating positive gender norms and describing what constitutes CSA and reporting procedures. The national standard operating procedures for the management of sexual violence against children lack CSA screening procedures. There is urgent need for review of these laws and policies and development of multisectoral protocols at the national and county level, that outline roles and responsibilities for various service providers, supervisory and accountability measures and referral networks.

In the wake of reported scandals of child sexual abuse by Roman catholic priests in mainstream media in the 1980s/1990s and conviction of Catholic priests on similar charges in England and Wales, Lord Nolan was invited by the Archbishop of Westminster in 2000 to undertake a review of child safeguarding policies of the Catholic Church of England and Wales since 1994, known as the Nolan Report. The Nolan Report led to the establishment of the first Catholic Office for protection of children (COPCA) which remained operative from 2001-2007 before being later modified in light of the Cumberlege Review (2007) as the National Child Safeguarding Commission (NCSC) and the Catholic Safeguarding Advisory service (CSAS) since 2008 which continue to operate till today. This article conducts a hermeneutical analysis of the Nolan Report, the Cumberlege Report, the annual reports of COPCA and the National Catholic Safeguarding Commission from 2007 till 2017. Wider academic literature on the subject is included in order to critically examine the performance of these child safeguarding structures developed to prevent and control clerical sexual abuse and to evaluate the utility of the child protection measures in place within the Catholic Church of England and Wales, since 2001.

Intrafamilial child sexual abuse is the commonest, though the under-reported, form of child sexual abuse in Marondera District and Zimbabwe generally. However, little is known about what drives it and what practitioners know about it. This study explored the factors associated with the incidence of intrafamilial child sexual abuse in Marondera based on perceptions of Victim-Friendly Court professionals in the district. A semi-structured questionnaire was administered to twenty-five professionals from thirteen agencies implementing the Victim-Friendly Court initiative in Marondera. Relevant court records of intrafamilial child sexual abuse cases were also reviewed. Data were analyzed using thematic analysis, descriptive statistics and document analysis. The study revealed that intrafamilial child sexual abuse in Marondera is associated with very subtle structural factors which put children at risk of abuse, prevent children, families, and communities from reporting, and reduce the accessibility of formal systems of social control. There are 'conflicts' between normative/legal and traditional socio-cultural value systems such that there is no shared understanding of the fundamental issues driving this phenomenon. Policy/practice responses need to take cognizance of these peculiarities. As a basic first step, a comprehensive national prevalence study is required. Further in-depth research of the socio-cultural determinants of intrafamilial child sexual abuse is also recommended.

Introduction: Recently the guidelines for the diagnosis of paraphilic disorders in the International Classification of Diseases and Related Health Problems, Eleventh Revision (ICD-11), have been published., Aim: This article analyzes legal, regulatory, and policy issues relevant to the potential effects of the changes for the classification of paraphilic disorders in the ICD-11 in Germany., Methods: A forensic and a legal expert in Germany worked with other international experts to conduct this evaluation using an assessment guide provided by the World Health Organization., Main Outcome Measures: Possible effects of the changes for the classification of paraphilic disorders in the ICD-11 on forensic practice, health systems, adjudication of individuals who have committed a sexual offense, and the provision of treatment in Germany., Results: Results highlight the special situation of medical confidentiality in the German health system that facilitates the establishment of preventive networks for the treatment of pedophilic patients. The ICD-11 guidelines will help to clarify the boundary between pedophilic disorder and crimes of child sexual abuse. These will also establish a boundary with other paraphilic diagnostic concepts. We describe the central construct of criminal responsibility in the German legal system in relation to paraphilic disorders, the prominent role of expert witnesses, and the differences in the conceptualization of medical confidentiality within the health care system and within the legal system., Clinical Implications: The ICD-11 proposals for paraphilic disorders provide a clearer differentiation, as compared with ICD-10, between variants of normal sexual behavior and sexual behavior that involves a non-consenting person or entity. Particular patterns of sexual preference that are not of relevance to public health, the health care system, or the legal system, such as masochism and fetishism, will no longer be named psychiatric entities and will, therefore, be regarded as private behaviors and destigmatized., Strengths & Limitations: The assessment shows the specific legal situation in Germany for the treatment of paraphilic patients in a sexual medicine, psychiatric, and legal discourse. However, it was done only by a small number of experts., Conclusion: A conclusion of the analysis was that the more specific and narrower definitions in the ICD-11 diagnostic guidelines, compared with those in ICD-10, particularly for pedophilic disorder and coercive sexual sadism disorder, will result in a reduction in false-positive diagnoses. It is unlikely that significant unintended and negative consequences will occur as a result of implementing the ICD-11 guidelines for paraphilic disorders. Briken P, Boetticher A, Krueger RB, et al. Current Legal Situation for Patients with Paraphilic disorders and Implications of the ICD-11 for Paraphilic Disorders for Germany. J Sex Med 2019;16:1615-1622., (Copyright © 2019 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.)

This study explored the viability of preventive treatment services for individuals with sexual interest in children, in jurisdictions without mandatory reporting but where risk-related disclosures to authorities are permitted at therapists' discretion. Health professionals ( N = 112) were surveyed regarding their comfort, confidence, knowledge of relevant legal provisions, and personal disclosure thresholds, in relation to a hypothetical scenario of a client confiding pedophilic interest to seek help. Findings were mixed regarding implications for prevention service viability. Despite the complexities of the legal and ethical context of the study setting (New Zealand), predictions regarding professionals' uncertainty in relation to their legal and ethical duties, and displaying a bias toward disclosing information to authorities when permitted, were not fully borne out, although pervasive knowledge inaccuracies and associated training needs were revealed. Instead, general tendencies among respondents were toward comfort, confidence, and the inclination toward maintaining client confidentiality. Yet, widespread variance within the sample, and individuals' thresholds appearing rather unpredictable on the basis of demographic or professional variables, highlights likely barriers for potential clients in feeling safe enough to come forward. Given that preventive treatment viability in this context relies on self-referral, it is suggested that a purpose-designed preventive treatment service, with clear accessible confidentiality and reporting policies that are well within the law, could be the best way forward for viable preventive treatment in discretionary reporting contexts.

Background: Like many middle-income countries, knowledge about child sexual abuse (CSA) is limited in Indonesia. The national government has stated a commitment to protect children from the worst forms of abuse, yet the sensitivity of CSA along with the complexity of culture and law, present substantial challenges., Objective: This article reviews current knowledge about CSA in Indonesia, in the context of existing laws and policies that influence CSA prevention and intervention., Method: A systematic review of this research was conducted in the following manner: a review of scholarly literature and grey literature in English (19 papers) and in Bahasa Indonesian (11 papers), and a review of CSA-related Indonesian laws (4 documents) and policies (5 documents)., Results: This review finds that knowledge about CSA in Indonesia is still limited. The taboos on discussing sexual matters were identified as factors that impede reporting of CSA. Poverty also leads to increasing children's risk of sexual abuse. There was less attention to CSA occurring within family contexts and focus was more upon its occurrence outside of the family. The study identified that contradictory definitions of children within the law add to children's vulnerability to CSA; this is especially the case for girls. Current child protection strategies in prevention and intervention lack specific focus on CSA., Conclusion: Further research is needed to enable the development of evidence-based approaches to better harmonize the development of law and policy with contemporary knowledge about CSA., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht.

Background: Child sexual abuse continues to be a problem aggravated by difficulty of detection. The aim of this study was to compare intra-familial (IF) and extra-familial (EF) child sexual abuse cases in search of differential variables that may allow for better intervention and prevention., Method: A sample of 221 forensic/legal cases (44.8% IF and 55.2% EF) dealing with children between 3 and 18 years of age (75% female) was analysed., Results: IF sexual abuse was significantly more likely to occur more than once (p = .000; OR = 6.353), with greater delay in its revelation (>1 year OR = 8.132), and with younger victims (9.05 vs. 11.45; p = .000). Intellectual disability was more prevalent among EF victims (p = .017; OR = 3.053). There was a higher proportion of reconstructed families, more legal records, and more histories of domestic violence among IF sexual abuse families. Even among EF cases, 78% of abusers were known to the victims, and in around 80% of all cases the abuse was reported by a family member., Conclusion: Results point to the need for further development of detection programs in schools, police or health contexts since reporting by professionals is scarce.

Background: Allegations of child sexual abuse provide complex challenges to family court systems., Objectives: Despite being highly criticised in the academic research, this analysis examined whether and how the gendered concepts of parental alienation syndrome or parental alienation more broadly are still being used to rebut allegations of child sexual abuse in family court cases in Australia. Parental Alienation is broadly understood as the deliberate actions of one parent to disrupt and prevent children's ongoing relationships with their other parent, in this case through allegations of abuse., Methods: We examined 357 publicly available judgements of the Family Court of Australia between 2010 and 2015. Judgements were analysed qualitatively for key themes using N-VIVO software., Results: Five themes emerged in the data, including use of the concept of parental alienation, coaching, mothers as manipulative, mothers as mentally ill, and impact of the best interest of the child., Conclusions: Results indicate that judgements made in the Family Court of Australia are both similar and divergent from those made in other jurisdictions internationally. The complexity of responding to allegations of child sexual abuse for parents is discussed., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Competing Interests: None

Background: In response to child victims of sex crimes, Canadian police agencies are required to work collaboratively with child victim oriented community organizations. Such collaborations involve the navigation of potentially competing objectives of partner agencies., Objective: In our research, we examine police interpretations of collaborative responses to child victims of sex crimes in order to assess the challenges and benefits of police and community partnerships., Participants and Setting: We conducted 52 semi-structured interviews and focus groups with police officers working on one of different ten police service organizations across Canada in order to unpack the joint responses of police and community partner agencies to child victims of sex crimes., Methods: We coded and analysed focus group and interview transcripts for emergent themes pertaining to police interpretations of their collaborations with governmental and non-governmental organizations when responding to child victims of sex crimes. In focusing on the management and sharing of information, the complexities and practicalities of joint responses to child sexual abuse are revealed., Conclusion: Collaborative tensions, such as differing mandates and blurred boundaries, were present in all participating policing agencies, but police working in and alongside CACs were more likely to recognize that the safety and best interest of children was a shared goal across partner agencies. Operating in successful partnership requires clearly demarcated roles and mutual understanding and respect between both police and partnerships agencies., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

The current study considers reasons for the consistent focus of academic research and mainstream media on clerical child sexual abuse (cCSA) largely within the Roman Catholic Church, seeming to ignore cCSA in other Christian denominations and religions. This study includes an analysis of traditional mainstream media and case reports on cCSA in non-Catholic churches and other religious faiths. The authors highlight the inadequacy of research and identify a wide range of gaps in this so far neglected area. Commonalities of cCSA and institutional responses are identified across denominations and religions, and reasons for the apparent over focus on the Catholic Church are discussed. The mains potential reasons identified were: (a) the centralized nature of the Church's universal organizational stature and management structure; (b) the anti-Catholic political and media bias in Protestant-dominated developed countries; (c) secular legal systems with access to powerful lawyers and insurance companies to locate responsibility at organizational level in order to seek compensation and finally; (d) the organized institutional power exercisable by respective bishops to silence victims. Future research needs to move beyond analysis of existing academic literature, press, and case review reports to comparative empirical studies across denominations and religions.

Previous research on gender differences and delay of disclosure of child sexual abuse is inconclusive; some research has found that male victims are more likely to delay disclosure than female victims, while other studies have found no gender difference. The present archival study investigated this inconsistency by examining factors that interact with delay. Judicial outcomes of child sexual abuse cases were coded ( N = 4237) for variables related to the offense, the complainant-accused relationship, and court proceedings. Males and females differed with respect to delay only when the relationship between the complainant and the accused was established in the community (e.g., sports coach) or was a stranger to the child. When the accused was a parent, other relative, or a non-relative connected to the child through the family, there was no difference in delay between males and females. Further, males were more vulnerable in the community, as evidenced by a higher proportion of accused community members with male than female complainants, even though males represented fewer than 25% of cases in the database. These findings may help explain inconsistencies in gender differences in delayed disclosure. Implications regarding education about child sexual abuse are discussed, with a focus on male victims.

Background: Despite numerous studies and publications, there is still a common expectation that a medical assessment can confirm or rule out child sexual abuse (CSA). The truth is that CSA can never be ruled out and can seldom be confirmed on clinical grounds., Aim: The objective of this article was to suggest which aspects to consider when the expert medical witness in a CSA case needs to explain why CSA can seldom be confirmed and can never be ruled out. The importance of a sound medical and medico-legal history was discussed because the history was generally the only positive 'finding' of the assessment of children who have possibly been abused., Method: Authoritative sources were used to support the explanation of reasons for an absence of corroborative clinical findings in CSA, as defined by the World Health Organization. The authors structured the individual sections by providing a background on which to base the testimony. They then summarised the clinical forensic significance of the information which should be offered in the courts and which should reflect on the court records, to be taken into account in the eventual decision, which will be made by the court., Results: A guideline was provided for answering questions frequently posed to the expert witness in child abuse cases where there were no positive findings., Conclusion: A structure for the explanation of reasons for a normal clinical examination when evaluating children who may have been sexually abused may reduce the discomfort of medical witnesses and improve the quality of expert medical testimony.

The purpose of the study was to identify the most optimal sign of a victim of non-violent sexual intercourse with a minor based on the analysis of approaches to the definition of such a sign in the criminal legislation of different countries, as well as the doctrinal provisions of medicine and jurisprudence. In the process of research, such methods of scientific knowledge were used as: a dialectical approach, a comparative law method, general logical methods (analysis, synthesis, induction, deduction, generalization), as well as a dogmatic method. The study of criminal legislation of a number of foreign countries and proposals expressed in criminal law science allowed to identify the main approaches to the definition of the sign of a victim, the presence or absence of which should have criminal law significance for qualifying the act as non-violent sexual intercourse with a minor. Such approaches are: 1) the age approach, according to which a person who has not attained a certain age is recognized as a victim; 2) the medical-physiological approach, which involves reaching a victim of puberty; 3) the mixed approaches: a) cumulative, providing for a person to reach puberty and a certain age; b) alternative, providing for a person to reach puberty or a certain age. The advantages and disadvantages of each approach are analyzed. It was concluded that there is no universal approach to determining the most optimal sign of a victim of non-violent sexual intercourse with a minor, since all the considered approaches have both advantages and disadvantages. A legislator in each particular state should independently determine which approach to use, the age of sexual consent to establish, taking into account the peculiarities of the mentality, traditions, culture, priorities of criminal law protection. Moreover, when choosing an age or one of the mixed approaches, it would be advisable to raise the issue of differentiating the age of sexual consent of boys and girls.

In their article on the subject of risk assessment of online child sexual exploitation offenders, Hirschtritt and colleagues highlight an important finding derived from an analysis of group data which concludes that the vast majority of individuals convicted for accessing child pornography online (and who have had no prior conviction for a contact sexual offense) are at low risk of becoming a contact, hands-on, sexual offender. This commentary is intended to complement their observations by emphasizing the importance of performing a comprehensive psychiatric-forensic evaluation when assessing risk. It argues that greater emphasis should be placed upon reducing any risk that may be identified rather than simply asserting its presence. While not arguing against legal sanctions, this commentary questions their severity in some instances based upon the above noted finding. This commentary suggests that effectively addressing the mental health needs of child pornography accessors and exploring methods of primary prevention should be considered aspects of risk reduction., (© 2019 American Academy of Psychiatry and the Law.)

Laws that mandate reporting of child abuse have stirred global controversy. Mandatory reporting to authorities for different types of child abuse includes physical abuse, sexual abuse, emotional abuse, physical neglect, educational neglect, and emotional neglect. While the definition of child abuse differs from jurisdiction-to-jurisdiction, which covers a wide spectrum of abuse and maltreatment, employees who work in professions required to report child abuse include health care workers, educational employees, social workers, religious leaders, employees of divisions of child protective services, criminal justice and other governmental personnel, and child care professionals. Lack of a uniform definition of what constitutes child abuse causes problems for mandatory reporters, ranging from false arrest and malicious prosecution to failure to investigate ongoing child abuse. This article reviews international norms associated with mandatory reporting of child abuse and assesses court cases within the United States that involve mandatory reporting, identifying important issues and underlying problems with the current mandatory reporting system; it concludes with policy recommendations and suggestions for future research., (Copyright © 2019 Elsevier Ltd. All rights reserved.)