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Background: Child sexual abuse is a universal social challenge and the victims of childhood sexual abuse suffer a range of short and long term psychological, social, behavioral and physical problems that vary in different cultures. The study was carried out to explore the perceived impacts of childhood sexual abuse in Pakistan, because no such study was conducted in Pakistan earlier. Methods: Interpretative phenomenological analysis was used to analyze the data. A snowball sampling technique was used to approach the sample of current study. The sample of the study comprised ten female survivors of childhood sexual abuse of age ranged between 18 and 22 years (Mage= 20.10 years) with the education ranging from matric to BSc. Out of these participants, four were married and six were unmarried and belonged to different cities of Punjab, Pakistan. Data were collected via a semi-structured interview schedule and all interviews were verbatim transcribed. Results: A rigorous iterative process of data analysis resulted in three super-ordinate themes and ten sub-ordinate themes: Experiencing Abuse (emotional trauma, and physical distress), Psycho-social Distress (low self-esteem, negative self-concept, psychological pain, social suffering, and retaliation vs. forgiveness), and Sexual Difficulties (passive role, emotionally aloof, aversion from hetero-sexuality and avoidance). Conclusion: It was concluded that childhood sexual abuse is an intense experience that has short- and long-term negative impacts on the lives of female survivors and engulfs their lives as a whole. The study has implications for psychiatrists, psychologists, family counselors, social scientists, educationists, and parents. [ABSTRACT FROM AUTHOR]

AbstractBackgroundAimsMethodsResultsConclusionSurvivors of Child Sexual Abuse (CSA) are reported to have difficulties in trusting. Yet no previous study investigating CSA survivors’ subjective experiences of trust exists and there is a paucity of clinical research into constructs and definitions of “trust.”To use a phenomenological lens to investigate CSA survivors’ descriptions of trust relationships and trustworthy others by privileging their subjective experience. To better understand how trust can be built within therapeutic relationships.A qualitative methodology using Interpretative Phenomenological Analysis was conducted within the survivor-research paradigm. The researcher was a person with lived experience of CSA who co-produced the study with CSA survivor advisors and co-constructed interviews with 17 adult CSA survivors.Findings present a “Survivor Trust Enactment Model” that delineates the process of building/repairing relational trust and advancing “transactional trust.” Trust is portrayed as nuanced and formed across and according to context, including the demarcation of generalised and relational trust. The findings emphasise that trustees’ trustworthiness is key to building trust which challenges assumptions that survivors are deficient in trust.The foregrounding of subjective trust experiences challenges diagnostic and clinical views on trust deficiency in adult CSA survivors. The study develops clinical constructs of trust, considers implications for clinical practice, and indicates areas for further research into trust dynamics in therapeutic relationships. [ABSTRACT FROM AUTHOR]

Survivors of child sex trafficking (SCST) experience high rates of adverse health outcomes. Amidst the duration of their victimization, survivors regularly seek healthcare yet fail to be identified. This study sought to utilize artificial intelligence (AI) to identify SCST and describe the elements of their healthcare presentation. An AI-supported keyword search was conducted to identify SCST within the electronic medical records (EMR) of ∼1.5 million patients at a large midwestern pediatric hospital. Descriptive analyses were used to evaluate associated diagnoses and clinical presentation. A sex trafficking-related keyword was identified in.18% of patient charts. Among this cohort, the most common associated diagnostic codes were for Confirmed Sexual/Physical Assault; Trauma and Stress-Related Disorders; Depressive Disorders; Anxiety Disorders; and Suicidal Ideation. Our findings are consistent with the myriad of known adverse physical and psychological outcomes among SCST and illuminate the future potential of AI technology to improve screening and research efforts surrounding all aspects of this vulnerable population. [ABSTRACT FROM AUTHOR]

Attachment has emerged as a major topic of contemporary study on children’s social and personality development, with a rising acknowledgment of the impact of attachment type on children’s physical and mental health, personality development, and adult social connections. Although different factors determine attachment type in children, parental influence is the most essential. However, the impact of childhood maltreatment suffered by parents in their original families on the attachment type of their children and its internal mechanisms still needs to be investigated. Based on attachment theory and self-efficacy theory, this study explored the mediating role of parenting self-efficacy between parental childhood maltreatment and children’s different attachment types. The results showed that although parental childhood maltreatment did not directly predict children’s secure attachment, parenting self-efficacy significantly mediated the relationship between parental childhood maltreatment and children’s secure, resistant, avoidant and disorganized attachments. Meanwhile, parental childhood maltreatment negatively predicted parenting self-efficacy scores, and the mediating effect showed consistent significance between parents. These findings not only add to the existing literature of knowledge about the elements that influence attachment type but also give a theoretical foundation for mitigating the harmful impacts of parents’ early maltreatment experiences on their children’s attachment development. [ABSTRACT FROM AUTHOR]

This article presents a five-step clinical approach that describes a process for child sexual abuse survivors, who are now adults, to initiate a statement with their abuser, whereby the survivor can explain the abuse and its impact on their lives. This method may also have applicability for survivors of general child maltreatment. The timing of this intervention needs to be carefully assessed in a partnership between the survivor and clinician. Clinicians might consider this approach if they are conducting long-term psychotherapy with adult survivors of child maltreatment and child sexual abuse, in particular. In addition to delineating steps to be taken, the authors suggest a measurement path. This closure process provides a unique and unduplicated opportunity for personal and professional growth. [ABSTRACT FROM AUTHOR]

Although adverse childhood experiences (ACEs) are associated with lifelong health harms, current surveillance data on exposures to childhood adversity among adults are either unavailable or incomplete for many states. In this study, recent data from a nationally representative survey were used to obtain the current and complete estimates of ACEs at the national and state levels. Current, complete, by-state estimates of adverse childhood experiences were obtained by applying small area estimation technique to individual-level data on adults aged ≥18 years from 2019–2020 Behavioral Risk Factor Surveillance System survey. The standardized questions about childhood adversity included in the 2019–2020 survey allowed for obtaining estimates of ACE consistent across states. All missing responses to childhood adversity questions (states did not offer such questions or offered them to only some respondents; respondents skipped questions) were predicted through multilevel mixed-effects logistic small area estimation regressions. The analyses were conducted between October 2022 and May 2023. An estimated 62.8% of U.S. adults had past exposure to ACEs (range: 54.9% in Connecticut; 72.5% in Maine). Emotional abuse (34.5%) was the most common; household member incarceration (10.6%) was the least common. Sexual abuse varied markedly between females (22.2%) and males (5.4%). Exposure to most types of adverse childhood experiences was lowest for adults who were non-Hispanic White, had the highest level of education (college degree) or income (annual income ≥$50,000), or had access to a personal healthcare provider. Current complete estimates of ACEs demonstrate high countrywide exposures and stark sociodemographic inequalities in the burden, highlighting opportunities to prevent adverse childhood experiences by focusing social, educational, medical, and public health interventions on populations disproportionately impacted. [ABSTRACT FROM AUTHOR]

Childhood abuse can have long-term adverse outcomes in adulthood. These outcomes may pose a particular threat to the health and well-being of perinatal women; however, to date, this body of knowledge has not been systematically collated and synthesized. This systematic review examined the child abuse literature and a broad range of perinatal outcomes using a comprehensive search strategy. The aim of this review was to provide a clearer understanding of the distinct effect of different abuse types and areas where there may be gaps in our knowledge. Following PRISMA guidelines, EBSCO, PsychInfo, Scopus, Medline, CINAHL, PubMed, and Google Scholar databases and gray literature including preprints, dissertations and theses were searched for literature where childhood abuse was associated with any adverse perinatal outcome between 1969 and 2022. Exclusion criteria included adolescent samples, abuse examined as a composite variable, editorials, letters to the editor, qualitative studies, reviews, meta-analyses, or book chapters. Using an assessment tool, two reviewers extracted and assessed the methodological quality and risk of bias of each study. From an initial 12,384 articles, 95 studies were selected, and the outcomes were categorized as pregnancy, childbirth, postnatal for the mother, and perinatal for mother and child. The prevalence of childhood abuse ranged from 5–25% with wide variability (physical 2–78%, sexual 2–47%, and emotional/psychological 2–69%). Despite some consistent findings relating to psychological outcomes (i.e., depression and PTSD), most evidence was inconclusive, effect sizes were small, or the findings based on a limited number of studies. Inconsistencies in findings stem from small sample sizes and differing methodologies, and their diversity meant studies were not suitable for a meta-analysis. Research implication include the need for more rigorous methodology and research in countries where the prevalence of abuse may be high. Policy implications include the need for trauma-informed care with the Multi-level Determinants of Perinatal Wellbeing for Child Abuse Survivors model a useful framework. This review highlights the possible impacts of childhood abuse on perinatal women and their offspring and areas of further investigation. This review was registered with PROSPERO in 2021 and funded by an internal grant from Charles Sturt University. [ABSTRACT FROM AUTHOR]

Educational institutions and educators are significant in children's lives, and they have a crucial role in implementing policies, practices, and sexual education to enhance children's safety. Such policies and practices should be based on the voices of CSA survivors. This study explored child sexual abuse (CSA) survivors' viewpoints on their past experiences with educators and the educational system. A qualitative thematic approach was used to analyze 61 written testimonies collected in 2020–2021 by the Israeli Independent Public Inquiry on CSA. Two interrelated themes arose: (1) CSA survivors' retrospective perspectives of educators and the educational system's responses to signs of their CSA, described as ranging from abusive to life-saving. Specifically, they shared three types of responses: (a) harmful and hurtful; (b) dismissive and ignoring; and (c) accepting and attending. (2) The second theme described the survivors' messages to educators to promote constructive change. The survivors conveyed expectations that educators should play a central role in CSA prevention, detection, and intervention and, specifically, the need for educators to receive professional training, provide beneficial sexual education, and identify and respond to CSA. The findings promoted moving beyond individual-level interventions to focus on improving educational institutional and organizational cultures related to CSA in both national and international contexts. [ABSTRACT FROM AUTHOR]

Objective: Childhood maltreatment has been consistently linked to posttraumatic stress disorder (PTSD) symptoms among college students and yoga may buffer the effects. The current study examined the frequency of college student's yoga practice over the past year as a moderator of childhood maltreatment and PTSD symptoms in the past 30 days. Participants: A sample of 177 college students from a southern university. Methods: Participants competed an online survey in exchange for extra credit or entry into a gift card raffle. Results: Moderation analysis indicated that a more frequent yoga practice buffered the relationship between maltreatment and PTSD symptoms. Conclusion: Clinicians working with college students with a history of maltreatment are encouraged to make referrals to yoga classes. Universities are encouraged to adopt trauma-sensitive yoga programs. [ABSTRACT FROM AUTHOR]

Research on child sexual abuse (CSA) has increased in recent decades. However, the study of gender differences in this field is still scarce. The aim of this study was to analyze the differences in the characterization of CSA between Spanish adult men and women. The Juvenile Victimization Questionnaire was administered to 162 cisgender victims of CSA aged 18–63. Most of the abuses involved physical contact and were committed by a known person. Twenty percent of the victims indicated that they had developed a mental health problem that they believed was due to the CSA experience. Women suffered more CSA with physical contact and penetration, more types of abuse and more abuse by men, and were abused more frequently by a family member. Compared to women, men suffered more sexual abuse by women. Exploring gender differences in CSA could help to improve preventive strategies and interventions aimed at reducing the occurrence of this type of abuse and sequelae resulting from it. [ABSTRACT FROM AUTHOR]

The rate of incarceration in the United States has increased at an alarming rate in the past 30 years and thus so has the number of children having a household member incarcerated (referred to as household incarceration). Associations between experiencing household incarceration in childhood and later negative health and developmental outcomes are well-documented; however, the underlying mechanisms linking this childhood stressor and adult outcomes have been less well studied. Using state Behavioral Risk Factor Surveillance System survey data (N = 145,102), this study examines how experiencing household incarceration during childhood is associated with mental and physical health in adulthood and mediational pathways through suboptimal sleep (short or long sleep). Results indicate there were significant indirect effects of household incarceration to physical and mental distress through short sleep (≤6 hr per 24 hr) and long sleep (≥10 hr per 24 hr), and a significant indirect effect of household incarceration to body mass index through short sleep. Findings from the present study highlight indirect pathways through which household incarceration in childhood is linked with sleep health in adulthood and, in turn, to negative mental and physical health. Public Policy Relevance Statement: Mass incarceration in the United States has far-reaching health implications, including for the family and household members of those who are incarcerated. Healthy sleep functioning is known to buffer the effects of stress on health. Findings from the present study highlight that suboptimal sleep is one explanatory pathway linking household incarceration in childhood and diminished health in adulthood. Those who have experienced household incarceration in childhood should be targeted for preventive and interventive measures that optimize sleep duration, thus promoting overall mental and physical health. [ABSTRACT FROM AUTHOR]

Background: To investigate the educational outcomes of siblings of childhood leukemia survivors, explore determinants of school difficulties, and compare the rates of repeating grades between siblings and the general population. Methods: A cross‐sectional study of childhood leukemia survivors' siblings recruited through the Leucémies de l'Enfant et de l'Adolescent cohort, a French long‐term follow‐up program, was conducted, and education‐related data were obtained via self‐report questionnaires. Adjusted logistic regression models were used to identify variables associated with school difficulties and time since diagnosis. Rates of repeating a grade in middle school were compared between siblings and the general population of the same generation. Results: A total of 564 siblings with a mean time from diagnosis of 14.1 ± 6.4 years were included, among whom 139 (24.6%) repeated a grade, at an average of 6.4 ± 4.5 years after diagnosis. In multivariate analysis, the risk factors for repeating a grade were older siblings (odds ratio [OR] 2.3, p = 0.006), family financial difficulties (OR 2.8, p = 0.008), and history of repetition in survivors (OR, 2.5, p = 0.001). Sibling hematopoietic stem cell donors were at greater risk of repeating a grade long‐term after diagnosis (p = 0.018). Overall, siblings did not have a higher risk of educational delays at the end of middle school than the general population. Conclusion: Although the results are reassuring, socioeconomic and cancer‐related factors may have an impact on siblings' schooling long after diagnosis. Paying attention to siblings contributes to identifying the most vulnerable families, allowing more attention and appropriate resources to avoid long‐term repercussions. Additionally, supportive and targeted interventions can be developed to improve the organization of education and the health care system. [ABSTRACT FROM AUTHOR]

Research has demonstrated the predictive effect of maternal childhood maltreatment on adolescent internalizing problems. However, few studies have explored the mediating mechanisms of how mothers' experiences of childhood maltreatment are transmitted to their offspring's internalizing problems over time. The present multi-informant study investigated the potential mediating effects of maternal depressive symptoms and offspring's childhood maltreatment experiences on the relation between maternal childhood maltreatment and adolescent internalizing problems. A total of 823 Chinese youth (43.4% girls; Mage = 10.26 years, SD = 0.94) and their mothers participated in a two-wave longitudinal study with one-year intervals. Mothers reported their experiences of childhood maltreatment and depressive symptoms, while youth reported their childhood maltreatment experiences and internalizing problems. Findings of path analysis indicated that maternal emotional abuse at T1 could significantly predict adolescent internalizing problems at T2, after controlling for a baseline of adolescent internalizing problems. Maternal emotional abuse, emotional neglect, and physical neglect at T1 can influence adolescent internalizing problems at T2 through maternal depressive symptoms at T1 to adolescent internalizing problems at T1. Maternal emotional abuse at T1 displayed statistically significant indirect effects on adolescent internalizing problems at T2 successively through the pathway from adolescent emotional abuse at T1 to adolescent internalizing problems at T1. The findings supported the cycle of maltreatment hypothesis. The present study highlights the intergenerational link between maternal childhood maltreatment and adolescent internalizing problems, as well as reveals the mediating mechanisms in this relation. [ABSTRACT FROM AUTHOR]

Although adverse childhood experiences (ACEs) have been positively associated with adiposity, few studies have examined long-term race-specific ACE–BMI relationships. A Black and White all-women cohort (N=611; 48.6% Black) was followed between 1987 and 1997 from childhood (ages 9–10 years) through adolescence (ages 19–20 years) to midlife (ages 36–43 years, between 2015 and 2019). In these 2020–2022 analyses, the interaction between race and individual ACE exposures (physical abuse, sexual abuse, household substance abuse, multiple ACEs) on continuous BMI at ages 19–20 years and midlife was evaluated individually through multivariable linear regression models. Stratification by race followed as warranted at α=0.15. Race only modified ACE–BMI associations for sexual abuse. Among Black women, sexual abuse was significantly associated with BMI (B adjusted =3.24, 95% CI=0.92, 5.57) at ages 19–20 years and marginally associated at midlife (B adjusted =2.37, 95% CI= −0.62, 5.35); among White women, corresponding associations were null. Overall, having ≥2 ACEs was significantly associated with adolescent BMI (B adjusted =1.47, 95% CI=0.13, 2.80) and was marginally associated at midlife (B adjusted =1.45, 95% CI= −0.31, 3.22). This was similarly observed for physical abuse (adolescent BMI: B adjusted =1.23, 95% CI= −0.08, 2.54; midlife BMI: B adjusted =1.03, 95% CI= −0.71, 2.78), but not for substance abuse. Direct exposure to certain severe ACEs is associated with increased BMI among Black and White women. It is important to consider race, ACE type, and life stage to gain a more sophisticated understanding of ACE–BMI relationships. This knowledge can help strengthen intervention, prevention, and policy efforts aiming to mitigate the impacts of social adversities and trauma on persistent cardiometabolic health disparities over the lifecourse. [ABSTRACT FROM AUTHOR]

Background: Difficulties in access to therapy were highlighted by COVID-19 measures restricting in-person gatherings. Additional challenges arise when focusing on caregivers of child sexual abuse (CSA) survivors in particular, which are a population that has been historically difficult to engage with due to issues of stigma and confidentiality. Objectives: To present preliminary qualitative results from caregivers of CSA survivors. Methods: This study was conducted with caregivers of CSA survivors. Two hybrid webinar/focus groups were conducted using a video conferencing platform in fall of 2021 with two groups of stakeholders (11 caregivers and 5 moderators/clinical staff at Little Warriors, an intensive episodic treatment facility). Sessions were recorded, transcribed, and thematically-analyzed using standard qualitative methodology. Results: A total of 11 caregivers contributed to the data. Themes include: (1) Challenges of starting and maintaining treatment (i.e., emotional impact of intake day, challenges of enrolling), (2) Therapeutic benefits of specialized treatment (i.e., feeling safe and supported and the importance of trauma-informed care), and (3) Barriers and facilitators of treatment (i.e., avenues to scale-up and self-care). Conclusion: The importance of a strong therapeutic alliance was highlighted by both caregivers/clinical staff and further support is needed for families post-treatment. The present hybrid webinar/focus group also achieved engagement goals in a population that is typically difficult to reach. Overall, the response rate (12%) was equivalent to reported registrant attendance rates for general business to consumer webinars and the recommended focus group size. This preliminary approach warrants replication in other populations outside our clinical context. [ABSTRACT FROM AUTHOR]

There has been a drive toward the implementation of trauma-informed approaches within health and social care in Scotland. This paper reflects on my experiences of implementing such an approach within a legal setting, namely the Scottish Child Abuse Inquiry. [ABSTRACT FROM AUTHOR]

The article focuses on therapists' reflections on incestuous abuse continuing into adulthood, highlighting the complexity and scope of this phenomenon. Topics include the links between ongoing familial abuse and organized crime, the role of non-protective mothers in perpetuating abuse, and the need for better training for therapists to handle extreme trauma and dissociative disorders.

Adult survivors of childhood sexual abuse (CSA) may experience emotional, social, and psychological difficulties, heightened due to the interpersonal nature of harm. Despite the demonstrated effectiveness of trauma-focused treatments in the West, a culturally specific understanding of the needs of and treatments for survivors in South Asia is still in its infancy. The study aimed to systematically review research findings on the mental health impacts of CSA on adult survivors and current treatment approaches and their efficacy and acceptability in South Asia. Seven databases (Scopus, Ovid, CINAHL, ProQuest, EThOS, Google Scholar, and Dogpile) and five peer-reviewed South Asian journals were searched from inception until March 30, 2023. Searches included participants who were adult survivors of CSA of South Asian origin residing in South Asia. Studies on their mental health, different treatments, and the efficacy and acceptability of these treatments were included. Quality assessment tools were used to appraise the quality of included studies. The results were synthesized narratively. A total of 3,362 records were retrieved, and 24 articles were included in the final review. Twenty studies reported mental health impacts of CSA on adult survivors, four studies reported current treatments offered, and two studies were on recovery. However, no study focused on the efficacy or acceptability of the treatments being delivered. Even though the needs of adult CSA survivors in South Asia have been partly identified, there is very little research into the treatments for them. [ABSTRACT FROM AUTHOR]

Child abuse, neglect, and maltreatment (CANM) represents a significant public health threat. The study's goal was to identify factors contributing to CANM and its high recurrence. We utilized 2019–2020 National Child Abuse data to test a structural equation model of Child/Caregiver Disability variables; Home Instability variables; and CANM recurrence. We hypothesized a six-factor model with Home Instability as a mediator. Of 1,221,176 victims, 29.9% had a prior victimization. A four-factor, mediational structural equation model showed strong fit (GFI = 0.946, NFI = 0.919) and was superior to alternative models. The study provides a framework for community leaders to reduce CANM. [ABSTRACT FROM AUTHOR]

In this autoethnographic account of my experiences as a parent who discovers and attempts to respond to the abuse of her child, I highlight the ways trauma can remove access to storytelling as a sensemaking and healing tool in a crisis. I narrate how I experienced secondary trauma as a meaning-making black hole that blocked language's healing capacities, blinded me to important sensemaking turning points, and hampered my and my child's ability to ask for help. These experiences caused me to question many foundational assumptions I made as a health communication scholar and to see an interdisciplinary bias toward narrative resiliency. Narrating the inhibiting effects trauma has on emplotment, help-seeking, and meaning-making points to the uniquely communicative nature of trauma which enables narrative theory and health communication research to make strong theoretical contributions to better understand trauma and support appropriate trauma-informed practices. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: This paper acknowledges the profound and lasting impact of childhood abuse on substance use and homelessness. What this paper adds to existing knowledge?: It underscores the inherent value and humanity of every individual, regardless of their struggles.That a comprehensive approach to mental health care, encompassing medication, therapy and a secure environment, is imperative. What are the implications for mental health nursing?: Early intervention and recognising individuals who suffer in silence are paramount. Mental health nurses must have the courage to ask uncomfortable questions and truly hear the unspoken words.Mental health nurses should never underestimate the power of simply being present with someone during their darkest moments. This simple act can wield significant influence. [ABSTRACT FROM AUTHOR]

Sexual violence against children is a gross violation of children's rights and as well an undeniable global reality across all countries. This social ill occurs in various forms including rape, sexual assault, child sexual abuse etc. The objective of the study is to assess the level of knowledge, attitude and self-efficacy of secondary school teachers on child sexual abuse prevention. A descriptive cross-sectional design was used and a Convenience sampling technique was adopted for the study. A structured self-administered questionnaire was used. A sample of 164 teachers was administered questionnaires. The frequency table was used to find the percentages and descriptive statistics of the data, and also Chi-Square cross-tabulation was used to analyse the hypotheses with the aid of Statistical Packages for Social Science (SPSS) version 21.0 The findings revealed that 159 (97%) of the teachers have a good knowledge of child sexual abuse and 5 (3.0%) have poor knowledge of child sexual abuse prevention, 98 (59.8%) have positive attitude towards preventing child sexual abuse while 66 (40.2%) have negative attitude. 94 (57.3%) of the respondents have a high self-efficacy in child abuse prevention while 70 (42.7%) have low self-efficacy in child sexual abuse prevention. The results of this study showed that teacher's attitudes about child sexual abuse prevention are significantly related to self-efficacy in preventing sexual abuse but knowledge showed an insignificant relation to self-efficacy. It is recommended that teachers with poor knowledge of child sexual abuse should be trained on how to prevent the children from sexual abuse in the society which will enhance their knowledge. [ABSTRACT FROM AUTHOR]

Men who have sex with men (MSM) with history of childhood sexual abuse (CSA) are at high risk for HIV acquisition. One reason is posttraumatic responses compromise ability to accurately appraise risk for danger/vulnerability. Health behavior change models and related interventions assume risk perception can be changed in an enduring manner. Given paucity of studies examining how risk perception changes or sustains over time post-intervention, this underlying assumption is not confirmed. Among this particularly high-risk group who struggle with perceiving risk due to trauma-related cognitions, it may be accuracy of risk perception is fluid. The study primarily aimed to examine accuracy of HIV risk perception over time post-HIV prevention behavioral intervention. Leveraging data from a larger RCT, N = 190 MSM in Boston, MA and Miami, FL USA completed a psychosocial baseline assessment, an intervention aimed to increase awareness of personal HIV risk level, then four follow-up assessments three months apart for a year. Linear mixed effect models were used to examine the degree to which accuracy of HIV risk perception (vs. traditional construct of risk perception with no information about accuracy) predicts sex risk behavior over time delineated by between-person (trait level) and within-person (state level) effects. Majority (92%) of participants fluctuated in HIV risk accuracy over time post-intervention. Within-person risk accuracy (one's accuracy at any given timepoint) predicted sex risk behavior (condomless sex not protected by adherent PrEP) over time, but not between-person (one's average of accuracy). Findings have implications for intervention and counseling related to specific HIV prevention strategies. [ABSTRACT FROM AUTHOR]

Objectives: Recovery from sexual trauma can be complex and multi‐faceted. Most current psychological treatment protocols for trauma use a cognitive model of post‐traumatic stress disorder (PTSD). However, sexual trauma may include specific complexities beyond that of a cognitive model of PTSD, such as relational factors. The distress experienced after sexual abuse may involve variables not exclusive to a PTSD model. Compassion focused therapy (CFT) is an approach that incorporates evolutionary, relational and social perspectives. This study explored the relationships between variables associated with CFT, PTSD and distress in survivors of sexual abuse to determine the role of CFT‐related variables. Methods: 155 adults who had experienced sexual abuse or any unwanted sexual experience at any point in their lives completed online questionnaires pertaining to various CFT variables (self‐compassion, receiving compassion from others, having a fear of compassion from others, having a fear of compassion from the self, shame and self‐criticism) and questionnaires measuring global distress as the outcome of sexual abuse and PTSD symptoms. Results: An exploratory model involving CFT‐related variables explained significantly more of the variance (4.4%) in global distress than PTSD symptomology alone. Self‐criticism was found to be the variable with significant contribution. Conclusions: That CFT treatments, targeting self‐criticism, should be developed alongside the standard cognitive model of PTSD based treatments for survivors of sexual abuse was supported. Future research may explore experimental designs utilizing CFT in this population, as well as further investigations on the roles of these specific CFT variables. [ABSTRACT FROM AUTHOR]

Machiavellianism is characterized by manipulative behavior, lack of empathy, and a willingness to deceive and exploit others for personal gain. Research indicates that one factor that may increase the likelihood and severity of Machiavellianism in adulthood is maltreatment in childhood. However, few studies have attempted to untangle which specific instantiations of childhood maltreatment (e.g. abuse vs. neglect) are most associated with Machiavellianism. In our study, we investigate the association between childhood abuse and neglect on Machiavellianism in a sample of adult women and men recruited online (N = 278) using a Bayesian approach to multiple regression. Results suggest that higher levels of Machiavellianism are associated with physical neglect, with some influence of other forms of maltreatment depending on gender. These findings shed light on potential etiological influences on Machiavellianism and have implications for research on and clinical intervention with people with high levels of this trait. [ABSTRACT FROM AUTHOR]

Understanding child maltreatment on a national level is complicated by lack of consistency in definitions of abuse and reporting by state. Adolescents experience child maltreatment, but responses to their maltreatment likely differ from younger children due to differences in development and vulnerability. The present study examined state variations of adolescent child protective systems reports using data from the 2015–2019 NCANDS. We calculated the rates of maltreatment reports, substantiations, and maltreatment subtypes per 1,000 adolescents in the population. Findings revealed wide variations across all three measured rates. Examining state variations involved with CPS is critical to informing policy and practice solutions. [ABSTRACT FROM AUTHOR]

Drawing on a reflexive and embodied approach, this article examines the researcher's narrative inquiry, consisting of the conflicting feelings and messy thoughts that arose through her interviews with adults who had experienced child sexual abuse. The article highlights how embodied writing can enable access to other worlds by activating the physical senses and bringing researchers back to core bodily ways of knowing; these latter may be evoked by preconceptions, entangled discourses and social views and taboos concerning child sexual abuse. The article speaks to the emerging field of Embodied Critical Thinking and the concept of emotional reflexivity in qualitative research on sensitive, challenging and difficult topics. [ABSTRACT FROM AUTHOR]

Using a qualitative multi‐methods approach, this study explored the offence, survivor and perpetrator characteristics, and the lived experiences of child and adolescent survivors of child sexual abuse (CSA) in Ghana. We analysed the contents of local media reports of CSA cases from January 2015 to December 2020 in Ghana, after which we conducted semi‐structured interviews involving five female child and adolescent survivors of CSA. The media content analysis identified 529 eligible reports involving female (n = 516) and male (n = 13) survivors aged 11–18 years who knew the perpetrators. The perpetrators were all‐male youth and middle‐aged adults employed in low‐income status occupations. Defilement was the most reported sexual offence; the survivors were more likely to come from single‐parent families experiencing poverty and economic hardship. The perpetrators employed multiple methods to coerce and elicit compliance from their victims: confidence approaches, violence (blitz methods) and gifts. Content analysis showed that most of the survivors attributed their victimisation to family poverty and dysfunctional parent–child relationships. These findings underscore a need to develop prevention strategies that empower young females and males to identify, escape or avoid (potential) sexual predators and encourage reporting and disclosure of CSA victimisation to formal support institutions. [ABSTRACT FROM AUTHOR]

Background: Domestic, family and sexual violence is a prevalent health and social issue. Nurses may be exposed to higher rates of this violence in their personal lives compared to the community, but little is known about their polyvictimisation experiences or health and well-being impacts. Methods: An online descriptive, cross-sectional survey of women nurses, midwives and carer members of the Australian Nursing and Midwifery Federation (ANMF) (Victorian Branch) (response rate: 15.2% of nurses sent an invitation email/28.4% opened the email). Violence survey measures included: intimate partner violence (Composite Abuse Scale); child abuse and sexual violence (Australian Bureau of Statistics Personal Safety Survey items). Health measures included: Short Form-12; Fast Alcohol Screening Test; Patient Health Questionnaire-4; Short Screening for DSM-IV Posttraumatic Stress Disorder; well-being measures included: Connor-Davidson Resilience Scale, social support, and financial stress. Proportions were used to describe the prevalence of violence by sociodemographic characteristics and health and well-being issues; logistic regression predicted the odds of experiencing overlapping types of violence and of experiencing health and well-being outcomes. Results: 5,982 participants (from a parent study of 10,674 nurses, midwives and carers) had experienced at least one type of lifetime violence; half (50.1%) had experienced two or three types (polyvictimisation). Survivors of child abuse were three times more likely to experience both intimate partner violence and non-partner adult sexual assault. Any violence was associated with poorer health and well-being, and the proportion of affected participants increased as the types of violence they had experienced increased. Violence in the last 12-months was associated with the poorest health and well-being. Conclusions: Findings suggest a cumulative, temporal and injurious life course effect of domestic, family and sexual violence. The polyvictimisation experiences and health and well-being associations reported by survivor nurses, midwives and carers underscores the need for more accessible and effective workplace interventions to prevent and mitigate psychosocial ill health, especially in the recent aftermath of violence. [ABSTRACT FROM AUTHOR]

Impaired ability to develop trusting relationships, self-dysregulation, poor emotional regulation, poor self valuation, and relational sensitivity are key challenges for survivors of Childhood Sexual Abuse. These increase the risk of ruptures in the therapeutic relationship and dropouts. Nevertheless, there is little evidence of the role of therapeutic trust in CSA. We collectively present the findings of a 15-year research journey into CSA recovering. Central to recovering was the establishment and maintenance of trust. Trust was also key for client satisfaction and facilitating the recovering process. Trust mediated regulation of threat responses, facilitated empathy, and enabled accurate symbolisation and re-contextualisation of traumatic narratives. In an increasingly traumatogenic world, more clinicians will be called to respond to disclosures of abuse and maintain engagement. Given the lack of effective interventions for CSA/complex trauma, trust-based person-centred psychotherapies are a promising alternative for managing dropouts, supporting the therapeutic relationship, and facilitating change. [ABSTRACT FROM AUTHOR]

The paper examined how dissociation is experienced and manifested in the drawings and narratives of female survivors of childhood sexual abuse (CSA) diagnosed with dissociative identity disorder. Fifteen Israeli women filled out a self-report questionnaire consisting of demographics, traumatic events, and dissociation severity. Then, they were asked to draw a dissociation experience and provide a narrative. The results indicated that experiencing CSA was highly correlated with indicators such as the level of fragmentation, the figurative style, as well as with the narrative. Two main themes emerged: a constant movement between internal and external worlds, and distorted perceptions of time and space. [ABSTRACT FROM AUTHOR]

Purpose: Studies on sexual health following male child sexual abuse (CSA) have identified the negative effects of such experiences on body functioning, but little is known about male CSA survivors' ability to create emotional and physical closeness in romantic relationships. The purpose of this article is to explore how male CSA survivors perceive, experience and develop intimacy in romantic relationships, including both the challenges they face and the positive changes that enable them to grow and achieve healthy relationships. Method: The study has employed a qualitative research approach and is based on in-depth interviews conducted among adult male CSA survivors residing in Sweden. Participants were recruited through civil society organizations and an ad in a daily newspaper. Using reflexive thematic analysis, the results are presented in relation to two themes: (a) challenges of intimacy; and (b) building trust and close relationships. Results: The results show that participants desired couple relationships that included both sexual and emotional intimacy. The challenges of intimacy were related to compromised sexual identity, sexual dysfunctions and compulsions, emotional dysregulation, and body shame. Efforts to achieve intimacy were facilitated by disclosing abuse experiences, developing emotional bonds or awareness, embracing sensitivity, and having an empathetic and supportive partner. Conclusions: Reconstructions of abuse histories were both challenged and facilitated by the accessibility of various and shifting ideas about masculinities that co-exist in Sweden, which were important sources for meaning making and assisted the men in developing positive valuations of themselves as men. [ABSTRACT FROM AUTHOR]

Purpose: Previous studies shed light on the potential role of secure parental attachment in mitigating the effects of child sexual abuse (CSA) on the survivors' long-term psychological distress. However, few studies have explored both approach and avoidance coping strategies as mediators of the link between parental attachment and psychological distress in a nonclinical sample. The purpose of this study was to examine the respective mediating effects of approach coping and avoidance coping on the relationship between perceived parental attachment, CSA severity, and psychological distress. Method: Our sample included 427 adults with a history of CSA. Participants were recruited from various social media websites (e.g., Facebook, Craigslist, discussion board, university announcement board). We conducted a mediation analysis with bootstrapping. Results: We found that parental attachment significantly predicted CSA survivors' psychological distress. Additionally, both approach coping and avoidance coping mediated the effect of perceived parental attachment on psychological distress. CSA severity was found to be a nonsignificant predictor of psychological distress. Conclusion: These findings may help develop interventions that enhance CSA survivors' effective copings strategies to ultimately reduce psychological distress. [ABSTRACT FROM AUTHOR]

Purpose: Few studies have explored young child sexual abuse (CSA) survivors experience as Participatory Action Research (PAR) researchers, and no studies have included participant researchers who were survivors unknown to statutory child protection services, the latter, a particularly vulnerable group. This exploratory study aimed to trace the nature of engagement and discover the perceived practical benefits and drawbacks of PAR for survivor researchers who had conducted a study into survivor views on confidentiality. Methods: The 8 PAR researchers included six females and two males, aged 12 to 20 years. All self-reported significant mental health problems, and 2 reported a learning disability. PAR participation was traced over 7-months and their views on their experience was sought through an online discussion forum and face to face interviews. Results: PAR was found to increase survivor researcher self-confidence because of learning new skills and discovering others shared experience of abuse and isolation. PAR researchers reported a growth in trust with each other leading to further disclosure, and the seeking of support services. Drawbacks included sustaining engagement because of personal crises. Conclusions: PAR is reported as an empowering process for CSA survivors, however, future research is needed into the relevance of PAR for the development of support services, especially for those unknown to statutory child protection services. [ABSTRACT FROM AUTHOR]

Despite the well-documented link between child maltreatment (CM) and mental health, evidence suggests substantial variability in the post-traumatic sequelae of CM across cultures. The perceived acceptability of CM in one's community might moderate the association between CM and mental health, but little research has been conducted on it so far. This study examined how the perceived acceptability of CM may influence the relationship between CM experiences and post-traumatic symptoms in individuals from four different continents and if the pattern of associations is the same across countries. We recruited a sample of 478 adults from Cameroon (n = 111), Canada (n = 137), Japan (n = 108), and Germany (n = 122). We administered online questionnaires and performed multiple group moderation analyses for total CM, neglect, physical abuse, emotional maltreatment, sexual abuse, and exposure to domestic violence (DV). A significant positive main effect of CM on post-traumatic symptoms was found in the overall sample and in Cameroon; in Germany, only neglect and emotional maltreatment were positively associated to post-traumatic symptoms. Moderation effects were identified; the perceived acceptability of neglect in Cameroon and Germany and of exposure to DV in Cameroon had a dampening effect on the relationship between CM experiences and post-traumatic symptoms. Our findings confirm that CM experiences entail long-term post-traumatic sequelae that can vary across cultures and CM subtypes and further our understanding of this issue by showing that the perceived acceptability of CM may be an understudied moderator. [ABSTRACT FROM AUTHOR]

The essay titled "Splitting and the Use of the Object" by Steven H. Cooper explores the concept of splitting in psychoanalysis. Cooper argues that splitting should be understood as a cluster phenomenon that encompasses various psychic processes. He challenges the traditional view that splitting is a result of developmental deficiencies and suggests that it can also be a form of creative destruction and object finding. Cooper also discusses the historical and enduring nature of splitting in human society, highlighting its presence in debates about race and political conflict. Overall, the essay provides insights into the complexities of splitting and its significance in psychoanalytic theory. [Extracted from the article]

Children tend to answer yes-no questions with unelaborated "yes" and "no" responses, but the types of details likely omitted from unelaborated answers have not been explored. This study examined 379 4- to 12-year-olds' answers to yes-no questions in forensic interviews about CSA (N = 11,187), focusing on age differences in elaborated responses. As expected, older children elaborated more frequently than younger children. Our novel categorization of elaboration types revealed that although there were no age differences in children's use of nominal corrections (correcting a label), or in emphatic negations (giving forceful denials), older children were more likely to give narrative elaborations (providing additional narrative information), wh-elaborations (answering implicit wh-questions), and qualified elaborations (avoiding potentially misleading implications of unelaborated "yes" and "no" responses). The results suggest that children's developing understanding of the implied meaning of questions and responses helps to explain age differences in elaborative responses to yes-no questions. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Earlier reviews to discover research on interventions for children after neglect have concluded little was available, despite the well-documented prevalence and harmful effects of neglect on children. We revisited this question through a systematic literature review to discover the state of research on interventions for children who have experienced neglect. We searched MEDLINE, PsycINFO, ERIC, Sociological Abstracts and EMBASE for studies published between 2003 and 2021. Studies were included if neglect could be distinguished, and child outcomes reported. Eight reports describing six studies about six interventions were identified. These studies differed in interventions, age-groups, definitions of neglect, and outcomes. Four studies reported positive child outcomes though with varying degree of quality. More research is needed to inform a coherent theory of change following neglect. There remains an urgent need for research on interventions to help children recover from neglect. [ABSTRACT FROM AUTHOR]

A correction to the article "Adverse Childhood Experiences, Women Who Are Sex Traficked, and Social Service Utilization: Implications for Social Work," that was published in the July 2024 issue is presented.

Background: Adverse childhood experiences can impact physical and mental health throughout the lifespan. To support families experiencing adversity and improve child health and developmental equity, an integrated, multi-sector response is required. Child and Family Hubs (Hubs) are a feasible and acceptable approach to providing such a response. In the Australian context, a number of federal and New South Wales (NSW) state policies support an integrated, multi-sector response using Hubs to support families experiencing adversity. This study examined NSW policy stakeholder and health service manager perspectives on the barriers and enablers to translating policy into practice in the implementation of Child and Family Hubs. Methods: Semi-structured interviews were conducted with 11 NSW government policy stakeholders and 13 community health service managers working in child and family policy and planning or child and family community-based services. Interviews were of 30–60 min duration and explored stakeholder knowledge, perspectives and experiences around childhood adversity, and barriers and enablers to operationalizing policies supporting Hubs. Analysis of barriers and facilitators to implementation of Hub models of care was undertaken using the Consolidated Framework for Implementation Research (CFIR). Results: Key barriers that emerged included short-term and inconsistent funding, lack of resourcing for a Hub co-ordinator, limited support for evaluation and insufficient time to plan for Hub implementation. Key enablers included flexibility and adaptability of Hub models to meet local needs, formal change management processes, strong governance structures and engagement among Hub practitioners. Key insights included the importance of targeted strategies to support sustained individual practice change and the need for organization-wide commitment to enable the successful adoption and maintenance of the Hub model of care. Conclusions: This study provides valuable insights and contributes evidence around what is needed to strengthen and support the operationalization and scalability of the Hub model of care. Key recommendations for Hub practitioners include the importance of formal change management processes and establishment of strong governance structures, while key recommendations for policymakers include the need for sustainable Hub funding and a standardized, evidence-based framework to support Hub implementation and evaluation. [ABSTRACT FROM AUTHOR]

Child maltreatment and removal from home have been increasingly examined among marginalized groups but less so among multiracial youth. The present study examined 99 multiracial youth aged 11–17 (M = 14.18, SD = 1.79) years. Classification and regression tree analysis was conducted on demographic (age, gender, family religion, self-identified religious, English first language), type of maltreatment, and psychological (depression, dissociation, anger, post-traumatic cognitions) variables for three post-traumatic symptom clusters. Pathways of low and high risk were identified for reexperiencing symptoms, avoidance, and hyperarousal. The findings have implications for tailoring assessment and intervention processes for this highly vulnerable population. [ABSTRACT FROM AUTHOR]

Extensive research has been conducted on the link between trauma, child maltreatment (CM), and chronic pain. Although the risk of suffering from chronic pain among CM survivors has been established, much less is known about the experience of pain during CM incidents or whether such peritraumatic pain sensations are associated with later chronic pain. This scoping review was conducted to synthesize the existing literature on pain during and a short time following CM (i.e., peritraumatic pain). Utilizing the preferred reporting items for systematic reviews and meta-analyses guidelines, the current review included 11 manuscripts, which met the following criteria: (a) refer to physical pain experienced during or a short time after CM, (b) were published in peer-reviewed journals, and (c) were written in English. The review demonstrated that most of the included studies were not intentionally focused on peritraumatic pain, the majority used qualitative research methods, and all were cross-sectional. Furthermore, although validated questionnaires are available, most of the studies did not utilize such measures. Those that intentionally reported pain demonstrated its high intensity and prevalence in CM incidents, indicating that pain is inherently embedded in the experience of maltreatment. The findings spotlight an underdeveloped research realm on a phenomenon that may hold significant empirical, clinical, and legal implications. Research endeavors should initiate interdisciplinary bodies of knowledge to establish well-validated research methodologies that properly quantify peritraumatic pain in trauma and CM. [ABSTRACT FROM AUTHOR]

Aim: To examine how school environment, physical functioning problems, and behavioral problems explain levels of school participation (i.e. attendance and involvement) among young people with craniofacial microsomia (CFM) and other childhood‐onset disabilities, and whether participation‐focused caregiver strategies play a role in these relationships. Method: We conducted secondary analyses of a subset of data (n = 260 families: 120 with CFM and 140 with other childhood‐onset disabilities) from the second follow‐up phase of a longitudinal cohort study. We applied structural equation modeling with data collected from the Participation and Environment Measure – Children and Youth version, the Child Behavior Checklist, and the Pediatric Quality of Life Inventory physical functioning scale. Results: Model fit was acceptable to close (comparative fit index = 0.973; root mean square error of approximation = 0.055; standardized root mean squared residual = 0.043; Tucker–Lewis index = 0.958). School environmental support had a positive effect on young people's participation attendance and involvement, and physical functioning problems had a negative effect on participation involvement. The number of disclosed caregiver strategies had a significant positive effect on the relationship between school environmental support and school participation attendance. Interpretation: Findings confirm the effect of school environmental support and physical functioning problems on school participation and highlight the role of participation‐focused caregiver strategies to intensify the positive effect of school environmental support on school participation attendance. What this paper adds: Environmental support had a positive effect on participation attendance and involvement.Physical functioning problems had a negative effect on school participation involvement.Disclosed caregiver strategies intensified the impact of environmental support on participation attendance. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine the associations between adverse childhood experiences (ACEs) and the high levels of social service usage by women who are sex trafficked. Fifty (N = 50) women who were sex trafficked were surveyed using purposive and snowball sampling methods. The ACEs score for respondents ranged from 2 to 10 with an average score of 7.4 (SD = 2.3). Emotional and sexual abuse tied at 88 percent as the most frequently cited ACEs among the women in this sample. The prevalence of ACEs was significantly higher in this sample compared with known estimates in similar populations, ranging from 20 percent to 54 percent (p <.001). Considering the well-established link between ACEs and poor health outcomes, these findings point to the need for innovative and targeted social service provisions to women who were formerly sex trafficked that take into consideration the high level of ACEs of the women. Given the sociodemographic diversity of this sample, there is a need for services that are trauma-informed, innovative, and culturally sensitive in a variety of social service settings. [ABSTRACT FROM AUTHOR]

Objectives Childhood abuse has been extensively studied in relation to later-life health, yet relatively little attention has been given to understanding the nuanced dynamics across victim–perpetrator relationships. This study addresses this gap by identifying typologies of familial perpetrators of childhood abuse in a national sample and examining their associations with various health outcomes, including physical and mental health as well as substance abuse. Methods We used 2 waves of data from the Midlife in the US Study (n  = 6,295, mean age = 46.9 at baseline). The analysis was completed in 3 stages. Using Latent Class Analysis (LCA), we identified subpopulations of victims with distinct familial perpetrator histories. With assigned LCA memberships and propensity score weighting, we investigated the extent to which specific victim–perpetrator relationships are associated with health outcomes measured at baseline and a 10-year follow-up adjusting for other early-life risks. We evaluated whether the observed associations differ across the waves. Results Parental and sibling abuse commonly co-occur, surpassing the occurrence of single perpetrators. Although minimal health disparities are evident between sibling-only abuse and no/little abuse groups at baseline, parent-only abuse is associated with compromised health outcomes. Severe abuse from both siblings and parents is linked to the most adverse health outcomes. At the follow-up survey, the associations between familiar abuse and health outcomes weakened, particularly for substance abuse. Discussion This study, delving into family relationships, family violence, and health disparities, provides new evidence to augment our comprehension of the enduring link between childhood abuse and health within the family context. [ABSTRACT FROM AUTHOR]

Although different studies have found that exposure to intimate partner violence (IPV) in childhood is linked to IPV perpetration in adulthood, others have revealed null effects. Previous research has also found that some factors might mediate the relationship between exposure to IPV in childhood and later IPV perpetration. As far as we know, no studies examined the role of aggression in this relationship. This study aimed to analyze the link between exposure to IPV in childhood and IPV perpetration in adulthood and verify whether this relationship was mediated by aggression and its components (verbal and physical aggression, anger, and hostility). Two hundred and forty five men convicted of domestic violence, from prison and community, were recruited. Correlation analysis revealed a positive link between exposure to IPV in childhood, aggression traits, and specifically physical aggression, and IPV frequency in adulthood. Overall aggression traits and physical aggression traits were statistically significant mediator variables explaining almost 15% of the overall effect of exposure to IPV in childhood on overall IPV frequency in adulthood. These findings unravel the role of aggression in the perpetration of physical and total IPV, claiming our attention to the need to include strategies to increase emotion regulation and problem-solving strategies in intervention programs. [ABSTRACT FROM AUTHOR]

This qualitative study consisted of in-depth, retrospective interviews with participants over the age of 18 who experienced child sexual abuse. Through narrative analysis, study findings shed light on three overall findings: the perception of memories, the perception of grooming, and the perception of the lived lives of child sexual abuse survivors. Findings suggest that the narratives elicited from the participants included current views but also past experiences and anticipation about the future, including individual and societal levels of meaning. These narratives are furthermore entangled and inexorably linked – temporally, culturally, generationally, materially, and emotionally – and the results are thus presented from a holistic perspective. Study findings help explain the complex dimensions concerning the lived experiences of child sexual abuse. As such, this research speaks to the field of social and health care practitioners working with children and families facing the complex phenomenon of child sexual abuse. [ABSTRACT FROM AUTHOR]