When a parent is accused of child sexual abuse (CSA), parent conflict raises concerns about allegation credibility. However, little is known about how attorneys question children about parent conflict. We examined 21,863 question-answer pairs from 53 testimonies of 6- to 17-year-olds (M = 13.46) in cases involving accused parents (49.1% stepfathers, 42.1% biological fathers, 8.8% other). We identified parent conflict topics and analyzed differences by attorney, child age, question type, and child elaboration. Parent conflict arose in nearly all cases but served different purposes: defense attorneys used it to suggest allegations resulted from conflict, whereas prosecutors used it to contextualize delayed disclosure. Attorneys questioned younger children more often about coaching. Closed-ended questions and unelaborative responses predominated, although children elaborated more when describing general parent conflict than other conflict topics. Findings highlight parent conflict as a versatile rhetorical tool and the need for developmentally sensitive questioning.
Intrafamilial child torture is an extreme and distinct form of child maltreatment associated with high rates of child fatality. It is vastly under-researched and poorly understood, contributing to cases being overlooked or mishandled leaving child victims at high risk of serious harm. A broad conceptual definition that incorporates criteria to serve as red flags could greatly improve identification of potential cases and ensure that they are referred for more thorough assessment. This study was designed to assess level of professional agreement with such a proposed broad conceptual definition of ICT, derived from agreed-upon criteria found in the professional literature. Two hundred and fifty-three members of the Association of Professionals Solving the Abuse of Children were surveyed. Almost 90% endorsed the proposed conceptual definition and demonstrated high levels of recognition of key ICT red flags. Respondents also confirmed that ICT cases require a different level of professional intervention than typical child maltreatment cases.
Socio-ecological contexts shape trauma and recovery after sexual abuse, but little is known about these contexts, particularly for racial and ethnic minority families. We aimed to describe contextual stressors for Black and Latino families after child sexual abuse. We interviewed 30 Black and Latino, English and Spanish-speaking caregivers of children who were sexually abused. Interviews were analyzed using thematic analysis. Caregivers (87% mothers) reported two sociocultural stressors: (1) beliefs about sexual abuse (patriarchy and stigma) and (2) beliefs about help-seeking (trust in family advice and mistrust of mental health care). Caregivers reported one main systems stressor: sexual abuse evaluation, investigation, and legal processes. They described how experiences with multidisciplinary systems can lead to child re-traumatization, caregiver blame and powerlessness, and family and community identity-based stress. Our findings highlight areas of intervention to strengthen and uplift communities, improve child protection systems, and promote child and family well-being after sexual abuse.
In settler-colonial societies, indigenous children exhibit elevated risk of CPS involvement, but little is known about the comparative dynamics of indigenous disadvantage. We calculated the cumulative incidence of CPS involvement before age 18 years among indigenous and nonindigenous children in Australia and the United States in 2019. We applied period life-table methods to linked administrative records. Among indigenous children, the cumulative incidences of maltreatment investigation and of out-of-home placement were higher in the U.S. than in Australia, but investigations confirming maltreatment were more common in Australia than in the U.S. Indigenous-nonindigenous disparities in CPS involvement were larger in Australia than in the U.S. In both countries, indigenous-nonindigenous disparities decreased with age and were larger at later stages of CPS involvement. Comparative findings contextualize indigenous children's CPS involvement in settler-colonial societies, informing research into its causes and prevention.
This study examines 20-year trends in child sexual abuse (CSA) investigations within Canada's child welfare system, using data from the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS) between 1998 and 2019. Data in the current study represent all Canadian provinces/territories except for Quebec. Findings indicate a substantial decline in both investigated and substantiated CSA cases, particularly among children aged 0-7 and cases involving non-parental perpetrators. Substantiated investigations among the youngest children fell by more than 80%, highlighting a marked shift in the age profile of cases coming to the attention of authorities. The overall reduction in CSA investigations may reflect genuine decreases in abuse for certain subgroups, but may also signal changing thresholds for reporting, professional hesitancy, and structural constraints within child welfare and law enforcement agencies. Notably, fewer substantiated cases in 2019 involved police intervention or ongoing services compared with 1998, raising concerns about unmet needs, diminished access to justice, and potential erosion of public confidence.
Sexual and gender minority (SGM) youth face disproportionate hardships from systemic inequality and are overrepresented among youth at risk for commercial sexual exploitation (CSE), yet little is known about the help they desire as sexual risk escalates. Using data from a national online survey of 1272 SGM youth aged 13-22 in the United States, this study examined patterns and predictors of desired help across domains of need by level of CSE risk. Nearly all participants reported wanting help for at least one concern, with mental health needs most prevalent. Youth with confirmed CSE reported the highest rates of desired help across all domains, including mental health, sexual health, substance use, food, and housing. Socio-structural conditions, particularly unstable housing, food insecurity, and poor home conditions, strongly shaped help-seeking for basic needs and attenuated associations between CSE status and desired assistance. Findings indicate that SGM youth at risk for or experiencing CSE desire support.
Child sexual abuse (CSA) is a preventable public health problem. Prior research has evaluated whether child sexual abuse education and awareness programs increase knowledge and behaviors of both children and adults. However, there is limited research on whether state policies that require such training lead to better outcomes for children. In this study, we evaluate required child sexual abuse education and awareness policies on rates of child sexual abuse, physical abuse, and neglect reports and the proportion of these reports that receive an indicated or substantiated determination using NCANDS data. Results show that required education and awareness policies are associated with increases in reports of child sexual abuse, physical abuse, and neglect from educators, yet no significant association was observed for the proportion of reports that receive an indicated or substantiated determination. Requiring CSA education and awareness for children or adults leads to more reports of school children to child welfare agencies by educators.
The decentralized U.S. child welfare system has resulted in significant variation in practices and outcomes across states and counties. Despite growing attention to varying child welfare experiences based on urbanicity, particularly rural child welfare practice concerning younger children, few studies have examined how child welfare practices for transition-age youth (TAY) in foster care differ across rural and urban contexts. Using administrative data from California, this study examined differences in transitional housing placement programs for nonminor dependents, a specialized, treatment-oriented placement for high-acuity TAY. We found that urbanicity was not a significant predictor of living in a new transitional housing placement. Instead, the likelihood of living in a new transitional housing placement varied based on the supervising county’s transitional housing placement practices and TAY characteristics and experiences in foster care. Our results underscore the importance of ongoing research and policy and practice reforms to ensure equitable transitional housing support for TAY in decentralized systems, where inequities may otherwise persist.
The present study examined trajectories of social support among 3,899 parents with low income. Repeated-measures latent class analysis was employed to profile temporal trajectories of parental social support across a five-year period. Five distinct trajectories of parental social support were identified with differentiated risk across maltreatment indicators (i.e., observed harsh parenting behavior and child protective services [CPS] contact). Compared to parents with “High Support” (66%), parents with “Recovering Support” (7%) demonstrated significantly greater harsh parenting behaviors. Parents with “Low to High Support” (6%) and “Low Support” (7%) were significantly more likely to experience CPS contact. Parents with “Decreasing Support” (14%) demonstrated both significantly greater harsh parenting behaviors and were more likely to experience CPS contact. These findings underscore the need for time-sensitive, dynamic approaches to assessing protective factors and maltreatment risk, ensuring that interventions are targeted toward parents most likely to benefit from preventive support.
This study examines medication for opioid use disorder (MOUD) utilization within Ohio's implementation of the Sobriety Treatment and Recovery Teams (START) model. This study assesses whether MOUD is associated with improved parent and child outcomes. Using an observational design relying on administrative data, 449 adults with documented opioid use were included. Key outcomes included case length, percent of time sustaining sobriety, successful Ohio START program completion, out-of-home placement, and reunification. MOUD was the primary independent variable. Multilevel regressions were conducted to account for parents nested within families and counties. MOUD was significantly associated with longer case duration, a higher percentage of time sustaining sobriety, and greater odds of successful Ohio START program completion. MOUD was not significantly associated with out-of-home placement or reunification after children were removed. These results suggest that MOUD may support sustained recovery engagement among parents participating in child welfare treatment programs.
Guardianship is an increasingly popular alternative to adoption for children in foster care, but evidence of its long-term safety and continuity remains limited. Using California child protection system (CPS) records, the study followed all children born 1999-2005 who exited foster care to guardianship before age 18 (N = 16,408). Rates and predictors of post-guardianship CPS referrals and reentries were estimated and allegations were categorized as involving biological parents or guardians. Overall, 59% of children who exited to guardianship had a subsequent CPS referral and 19% reentered care. Thirty-four percent of postguardianship referrals involved alleged maltreatment by the biological parent from whom they were originally removed, and 68% involved alleged maltreatment by the guardian or another relative. Older children (ages 15-17) had the greatest risk of foster care reentry, while children in kin guardianship had significantly lower risk. Findings underscore the need for caregiver screening and enhanced postguardianship supports.
This study examined mental health service use among 75,784 Australian young people from families with different intergenerational patterns of child protection (CP) contact evident in longitudinal multi-agency administrative data, namely cycle maintainers (parental and offspring CP contact), cycle initiators (only offspring CP contact), cycle breakers (only parental CP contact), or no CP contact. Young people from cycle maintainer families had the highest prevalence of mental health service use (76%), followed by those from cycle initiator (70%), cycle breaker (53%), then no CP contact families (49%). Young people from cycle maintainer and cycle initiator families accessed mental health services earlier than those from cycle breaker and no CP contact families. While those from families with cumulative intergenerational CP involvement were the most likely to use mental health services, young people's mental health service use appeared to be more closely linked to their own CP contact than to that of their parents.
Use of telehealth for behavioral health services has rapidly expanded with potential to reduce rural health disparities. Applying evidence-based treatments for problematic sexual behavior (PSB) among youth via telehealth can prevent further sexual harm of children. Successful implementation of telehealth in rural communities requires examining the acceptability, understanding, barriers, and facilitators of the approach. Using a qualitative approach, this study explores family and clinician perception of the utility of telehealth to enhance access to PSB cognitive behavioral group treatment (PSB-CBT) services. Results revealed telehealth provided opportunities to address internal (e.g., shame, stigma) and external barriers (e.g., time, transportation, childcare), as well as impact of unique rural communities' characteristics. Privacy, safety, reduced isolation and shame, and enhanced sense of community among members were noted as benefits of group telehealth, while technology literacy, device accessibility, and group appropriateness were reported obstacles. Strategies to enhance success included telehealth orientation, loaning secure devices, integrated therapeutic activities, focused efforts on building relationships among members, and augmenting with family sessions. Future research on implementation and treatment outcomes of group telehealth for PSB is recommended.
The role of subjective experience in understanding the links between childhood physical abuse and mental and somatic outcomes is gaining recognition but remains underexplored. Using data from a large population-based sample of youth (12–16 years) and generalized linear models, we examined whether current and past peak subjective distress following physical abuse were associated with symptoms, measured by the Hopkins Symptom Checklist (HSCL-10) and the Children’s Somatic Symptoms Inventory (CSSI-8). Causal mediation analyses were conducted to investigate whether subjective distress mediated the relationship between physical abuse and health outcomes. Subjective distress accounted for variation in symptoms, above and beyond severity and frequency of physical abuse. The impact of physical abuse on health was largely transmitted through subjective distress. While severity and frequency of maltreatment remain independent predictors of health outcomes, this study underscores the necessity of incorporating measures of subjective experience to understand the pathways linking childhood physical abuse to later health outcomes.
U.S. children suffer higher rates of death resulting from violence than children in economically comparable countries. Prevention of violent injury relies on robust data regarding demographic and contributing factors. This retrospective study of records from the New Mexico Office of the Medical Investigator (OMI), the University of New Mexico Children's Hospital (UNMH), and the UNMH child protection team examined demographic and risk factors for child deaths and near-deaths resulting from violence or maltreatment (abuse or neglect) during the period August 1, 2019 - September 30, 2022. The OMI is the only forensic laboratory in the state, and UNMH is the state's only pediatric trauma hospital. 76 children met inclusion criteria; 60 of these died. Most victims were male. Firearm injuries were most common among adolescents, and other injury mechanisms predominated among younger victims. Parent intimate partner violence (IPV) was more common among children who suffered non-fatal injuries than fatal; and parent IPV, current or prior child protective services involvement, and parent substance use were identified more often in children with non-firearm injuries versus firearm. Other risk factors did not discriminate between groups. Pooling data for serious non-accidental child injury would increase the data available for epidemiologic studies and prevention efforts.
Increasingly, communities across the U.S. are looking to prevent families from unnecessary involvement with the child welfare system. Community-based participatory research methods, like community cafés, offer a framework for developing solutions in partnership with groups impacted by the child welfare system. The present study, which is part of a larger child welfare prevention demonstration project, is among the first to use community cafés with families and mandated reporters to inform the design of a community response program. Evaluators worked with local partners to host eleven community cafés in three states, mainly in rural areas. Conversations centered on the need for voluntary, tailored, and affirming support for families. Participants living in rural areas emphasized the unique service barriers impacting families in their communities. These collective insights from families and mandated reporters shine a light on opportunities to improve community response programs, including meeting the needs of families in rural areas.
One way attorneys challenge witnesses' credibility is through impeachment by prior inconsistent statements. We examined the testimony of 6- to 12-year-old child witnesses in 120 sexual abuse prosecutions and identified 96 cases in which attorneys challenged children with prior testimony that was allegedly inconsistent with the child's current statements. In 11% of the cases, the statements were not in fact inconsistent. In 94% of the remaining cases, we identified one or more of 12 developmental difficulties with the question-types or topics potentially leading to the inconsistencies. This included suggestive tag questions in 45% of the cases, which always co-occurred with other question-type or topic difficulties. The most common problems (appearing in more than 20% of cases) included questions about time and number, questions requiring the child to distinguish among individual incidents, sexual terminology, and questions using negative polarity items such as "any" and "ever."
Problematic sexual behavior (PSB) among youth presents a persistent challenge within child welfare and multidisciplinary response systems. Because multidisciplinary responses shape investigation, referral, and service decisions, it is important to understand how professionals-including clinicians, law enforcement, child advocacy center staff, child welfare professionals, and prosecutors-perceive children who act out sexually on other children. This study examines how case and respondent characteristics jointly shape professional perceptions of PSB using vignette-based survey data from 363 multidisciplinary team members across Texas. Respondents assigned to vignettes involving a 14-year-old child displaying PSB were more likely than those assigned to a 10-year-old to agree the child was old enough to accept responsibility, knew the behavior was wrong, and should face criminal consequences. Political ideology, professional role, and geographic area of practice were each independently associated with these judgments. Mental health professionals and liberal-identifying respondents were less likely to endorse criminal consequences, while court/legal professionals and conservative-identifying respondents showed opposing patterns. Suburban practitioners were more likely than rural practitioners to endorse responsibility and knowledge of wrongdoing, while urban practitioners were less likely to endorse criminal consequences. Findings highlight the need for developmentally informed, coordinated approaches to training and intervention across multidisciplinary systems.
State-funded child maltreatment prevention aims to reduce risk, but whether reach aligns with community need is unclear. This county-level cross-sectional study of all 254 Texas counties examined whether Fiscal Year 2023 Prevention and Early Intervention (PEI) service distribution tracked structural risk and substantiated maltreatment. Two outcomes were modeled with negative binomial regression and a log child-population offset: annual family service recipients (home visiting and family support) and average monthly youth service recipients (community-based programs). Structural risk was operationalized through socioeconomic, housing, and violent crime indicators. In fully adjusted models, family service rates were approximately ten times higher in urban than rural counties (incidence rate ratio [IRR] = 10.52, 95% CI [4.74, 23.33]) but unrelated to substantiated maltreatment. This urban-rural gap was absent for youth services, which tracked substantiated maltreatment (IRR = 1.44, 95% CI [1.07, 1.93]). Family prevention reach in Texas tracks geography rather than need, while youth prevention tracks observed maltreatment burden - patterns implicating distinct allocation pathologies in state-administered prevention.
