This paper provides results from a survey on the practices and challenges for multidisciplinary investigation teams working with abuse cases that involve child sexual abuse material (CSAM) at Children's Advocacy Centers (CACs). Survey respondents were primarily executive directors of 379 CACs from across the United States. Most CACs had a process before the forensic interview for investigators to discuss CSAM (88.4%), regularly screen for CSAM (69.1%), and document CSAM in a case tracking system (71.2%). Although half of CACs required CSAM training for forensic interviews (54.9%), it was less common for other multidisciplinary members. About one-third of CACs reported helping families remove images from the internet. Over half (59.9%) of CACs reported collaborating with schools to provide CSAM education, with 69.7% indicating that this was a practice of top importance. Most participants mentioned the need to provide support and resources to parents as one of the top challenges as well as one of the top important practices when working with victims of CSAM. Overall, there were more similarities than differences across small and large CACs, suggesting that multidisciplinary team members across all CACs, regardless of size, would benefit from active discussions about improving the CAC response to cases involving CSAM, identifying more ways to support families in these cases, and accessing additional opportunities for training on providing care to victims.

Background: Relatively little empirical research has examined how child sexual abuse material (CSAM) cases are referred to Children’s Advocacy Centers (CACs).Objective: This study examined CSAM cases investigated at U.S. CACs, comparing cases where the CSAM was part of the referral versus discovered during the investigation. Participants and Setting: Participants were 324 professionals from 142 CACs who reported on their most recent CSAM case. Methods: Online survey of multidisciplinary professionals.Results: When CSAM was part of the referral reason, cases were significantly more likely to be first reported by an Internet provider/social media company compared to cases when CSAM was discovered during the investigation (15.2% vs. 2.5%). When CSAM was discovered during the investigation, a youth was significantly more likely to first report the case compared to when CSAM was part of the referral reason (13.6% vs. 6.6%). When CSAM was discovered later, cases were significantly more likely to have two or more additional types of abuse compared to cases when it was part of the referral reason (54.3% vs. 32.1%). Cases were equally likely to have a high volume of sexual images, livestreaming, high image explicitness, and a similar severity index regardless of when the CSAM was identified. When CSAM was part of the referral reason, it was significantly more likely that two or more professionals viewed the CSAM compared to cases when it was discovered later (43.6% vs. 30.9%). Conclusions: Results highlight the complexity of CSAM cases and indicate the importance of routinely assessing for potential CSAM during investigations involving other types of abuse.

Objective: To describe the characteristics and consequences of online commercial sexual exploitation of children using a nationally representative sample. Method: The online survey sample comprised 2,639 respondents aged 18-28 from the KnowledgePanel maintained by the survey research firm Ipsos. Results: Fifty-eight respondents or a weighted 1.7% of the sample described childhood experiences in which they used technology to exchange sexual talks, sexual images, or other sexual activities for money, drugs, or other valuable items. The episodes were very diverse. Sixty-three percent were girls, 30% boys, 7% gender fluid, and 42% sexual minorities. Half were ages 16 or 17, and half were younger at the time of the activity. Many (44%) were involved in offline sexual activity. The purchasers were not exclusively anonymous internet contacts; 19% were current or former intimate partners and another 10% friends or acquaintances. Most of the exchanges (92%) were self-negotiated, and only 8% involved a facilitator. Nonetheless, most reported negative reactions involving embarrassment, anxiety, and feeling afraid. Sexual minority youth reported more exchanging sexual talk, having a facilitator involved, feeling afraid and falling behind in school or work than heterosexual youth. Conclusions: This national survey reveals a high frequency of childhood commercial sex that diverges from descriptions of dynamics based on police and social agency data. Such dynamics suggest the need for alternative approaches to prevention.

Most emergency medical clinicians are not trained to conduct forensic sexual assault exams yet are often the first to care for survivors of recent sexual assault. Before the implementation of live sexual assault nurse examiner (SANE) consultation provided via telemedicine (“teleSANE”) in one state, results of an online survey of emergency nurses ( N = 116) found only 13% felt extremely confident providing quality forensic sexual assault examinations. Two-thirds of emergency nurses felt using teleSANE during sexual assault care would support their clinical decision-making skills. Findings suggest that teleSANE may be a promising strategy to improve access to specialized sexual assault care.

This study analyzed caregiver feedback regarding referrals, service use, and wanting additional services using a standardized survey completed by 1,585 caregivers at 260 Children's Advocacy Centers. Most caregivers were referred to counseling or support services for their child (84%). Caregivers who completed the survey in Spanish were significantly more likely to receive referral information for themselves, have children use the services, use the services themselves, report being on waiting lists, want additional services for their child, and believe staff could have done something additional compared to caregivers who completed it in English. African American children were significantly less likely to receive referrals, use services and have caregivers want additional services. Spanish-speaking caregivers and African American children warrant more attention to ensure all families' needs are being addressed.

Using the nationally representative Ipsos online KnowledgePanel, the sample included three hundred thirty-six 18- to 28-year-olds who retrospectively reported first cyberstalking incidents as juveniles (9- to 17-year-olds) or adults. Half of the sample first experienced cyberstalking as juveniles and half first experienced it as adults. Juveniles were more likely to have more than two perpetrators in the same episode, to experience more violent threats, and to avoid people because of what happened. Few reported the incident to the police, with juveniles less likely to report it to the police. Cyberstalking of juveniles appears just as or more serious than cyberstalking of adults.

ABSTRACT Introduction Emergency department (ED) nurses play a critical role in caring for sexual assault patients, but many have not received training on how to conduct a proper sexual assault forensic medical examination. Live or real-time sexual assault nurse examiner (SANE) consultation provided via telemedicine (known as “teleSANE”) during sexual assault examinations is a promising new practice to address this issue. Purpose The purpose of this study was to assess ED nurses' perceptions of influences on telemedicine use, as well as the utility and feasibility of teleSANE, and identify potential influences on teleSANE implementation in EDs. Methods Guided by the Consolidated Framework for Implementation Research, this developmental evaluation involved semistructured qualitative interviews with 15 ED nurses from 13 EDs. Results Interviews revealed facilitators and barriers to current telemedicine use across Consolidated Framework for Implementation Research levels. Facilitators included state-level grant funding and technical assistance. Barriers included clinician discomfort being on video and access to ongoing training. Participants believed teleSANE consultation would improve patient care and forensic evidence collection but had concerns for patient privacy and acceptability. Most participants worked in EDs that have the information technology support and telemedicine equipment needed to support teleSANE implementation, although many requested ongoing education and trainings on teleSANE and sexual assault care to improve clinician confidence and account for high staff turnover. Discussion Findings highlight the unique needs of sexual assault survivors receiving telemedicine services in EDs, particularly those in rural communities with heightened privacy concerns and limited access to specialty care.

In this study, we explored survivors' experience with sextortion (threats to expose sexual images to coerce victims to provide additional pictures, sex, or other favors). We conducted in-depth telephone interviews with 48 adults aged 18 to 25 who had been targets of sextortion. Nearly half of participants were minors at the time of the sextortion incident. Data were analyzed using thematic analysis, which resulted in four major dimensions. The dimensions identified were the emotional connections between victims and perpetrators, the nature of the threats, societal responses, and integrating the sextortion into their life stories. The findings emphasized the multidimensional nature of this phenomenon. There was a wide range of emotional connections, from brief connections to close intimate relationships or strong friendships. Some threats remained unfulfilled, while other were carried out. Some threats were one-time and some lasted for years. Societal responses were central in participants' narratives, with most participants actually turning to their peers and parents for support. Many expressed thankfulness for the opportunity to tell their story during the interviews. For the majority of participants sextortion was perceived as a central event in their lives, one that changed them forever. Listening to the voices of survivors helps professionals understand these harmful situations.

Statutory rape laws are intended to protect adolescents from harm as a result of sexual activity with older individuals. In this pursuit, many, but far from all, states' statutory rape laws differentiate younger and older offenders. In effect, many of these states differentiate offenders who are 21 and older from those who are under 21. It is unknown, however, whether and how the dynamics of statutory rape vary depending on the age of the offender. To explore the contribution of offender age to the dynamics of statutory rape, data were collected from the records of 105 statutory rape cases referred to a child abuse assessment center over a 63-month period. Records included detailed reports on case history and victims' family history, mental health and health-risking behaviors, medical examination results, and forensic interview summaries. Cases of offenders11.Because these cases are under investigation, "offenders" here refers to "suspects." For ease of reading, we use "offenders" to be consistent with prior research terminology. under 21 were compared to the cases of offenders 21 years and older. Compared to cases of younger offenders, cases of offenders 21 years and older more often involved slightly older adolescent victims. Independent of age, victims with offenders 21 and over compared with offenders under 21 were over six times as likely to have a prior history of a high, versus low, number of psychosocial problems and were seven times more likely to experience multiple forms of coercion versus no coercion by the offender. Findings suggest that statutory rape prevention, policy and response strategies should consider the critical ways that case characteristics and victims differ according to this key offender attribute.

Children’s and adolescents’ risk of experiencing criminal interpersonal violence is disturbingly high, but most cases are neither reported to police nor prosecuted. Yet significant progress has been made in the criminal justice response to child and adolescent victimization. Hundreds of forensic interviewers are trained in interviewing protocols based on developmental research. Many police and prosecutors receive support from multidisciplinary teams. Through Children’s Advocacy Centers in the USA, thousands of child victims have access to trained interviewers, medical help, family support, and evidence-based mental health services. Specialized methods have been developed for conducting child victimization investigations and gathering corroborative evidence. Factors such as child age, mental health, and family support affect whether abuse is prosecuted. Children’s testifying in court can be very stressful and negative. Countries vary in requiring child victims to testify at trial. Children who testify may do well if they have the preparation and support they need, can testify in a timely way, and do not have to testify repeatedly. Cases are much more likely to be resolved by guilty pleas than convictions at trial. The alternative of restorative justice methods may increase victims’ psychological experience of justice, but require managing the risk involved with contact with the perpetrator. Most of the attrition of child victim cases occurs at the “front end” of the criminal justice system, where lies the greatest potential for system improvement. In coming decades, professionals working with child victims should strive to disseminate promising methods and test them through research.

Sexual assault, partner abuse, and stalking are major problems on college campuses. Past research has demonstrated a host of physiological and psychological outcomes associated with victimization; however, there has been little research conducted on the potential academic outcomes associated with victimization. The purpose of this study was to measure the relation between academic outcomes and experiences of sexual violence, intimate partner violence, and stalking victimization among college students. A sample of 6,482 undergraduate students currently enrolled at one of eight universities in New England was surveyed using items from the subscales of the College Persistence Questionnaire (Academic Efficacy, Collegiate Stress, Institutional Commitment, and Scholastic Conscientiousness). All four types of victimization were associated with significant differences on academic outcomes after controlling for sex and year in school, with victimized students reporting lower academic efficacy, higher college-related stress, lower institutional commitment, and lower scholastic conscientiousness. Polyvictimization was also significantly correlated with outcomes, with the greater number of types of victimization experienced by students being associated with more negative academic outcomes. Implications for future research and campus response were discussed.

Cross-agency collaboration for responding to child abuse cases is critical for the safety and wellbeing of children. However, working effectively across organizational boundaries can be difficult, especially where there are considerable disciplinary differences. Accordingly, many jurisdictions have put in place policies and processes to support cross-agency collaboration across groups responding to severe child abuse. The aim of this scoping review was to highlight key factors that may influence the quality of cross-agency collaboration in severe child abuse cases. A systematic search comprising 57 empirical studies examining the facilitators and/or barriers to cross-agency collaboration in child abuse cases was undertaken identifying eleven factors. This review found the most commonly cited factor was the need to reconcile the different roles/mandates of workers with their roles in a cross-agency response. A clear cross-agency protocol that establishes agreed procedures was also a commonly cited factor, along with cross-agency training, and communication and information sharing practices. This scoping review highlighted the lack of high-quality evidence that could be used to assess the effectiveness of policies and processes to support cross-agency collaboration for child abuse cases, and targeted areas for future research to enhance the quality of evidence for this common type of program/intervention.

ABSTRACT Objective Improved access to qualified nurse examiners to perform sexual assault forensic examinations is needed. This integrative review examines the current research literature on synchronous “real-time or live” telehealth support and guidance during pediatric, adolescent, and adult sexual abuse/assault forensic examinations. Methods Informational databases (CINAHL, Health Source: Nursing/Academic Edition, Medline, PsychInfo, and Violence & Abuse Abstracts) were searched, and research articles including live telehealth for sexual assault survivors were reviewed (n = 98). Results Review of the articles resulted in the inclusion of seven studies that utilized live video telehealth during the sexual assault forensic examination. Conclusion The current research literature supports the premise that synchronous telehealth is a promising modality for this patient population. However, the lack of large comprehensive studies warrants additional research to understand outcomes and develop best practices. Additional research studies are needed to evaluate the effectiveness, cost, and criminal justice impact of this intervention.

INTRODUCTION:This project describes the first time live sexual assault nurse examiner (SANE) services were provided via telehealth to support site clinicians conducting sexual assault forensic medical examinations for adult and adolescent patients. It involved six sites in three states, including rural, tribal, military, and community hospitals. The purpose of this process evaluation was to determine the extent to which patients consent to telehealth technology, examine how the technology worked, and explore the types of assistance.METHODS:We reviewed information for sexual assault patients who presented at emergency departments (N = 215) and conducted telephone and online surveys with 178 clinicians who provided or received telehealth services.RESULTS:Between May 1, 2015, and March 31, 2018, 129 patients and site clinicians received services via telehealth and an additional 86 site clinicians received consultation advice via telehealth. Most patients consented and accepted SANE services via telehealth (86% overall and 97% in non-U.S. Navy sites). No significant technology problems were experienced for most interactions (92%). The assistance provided remotely by SANEs to site clinicians included guiding clinicians through history taking and documentation, forensic examination and evidence collection techniques, identifying and documenting injuries, and guiding clinical practice. Site clinicians reported, on average, a positive impact of the assistance on their confidence in providing an effective examination, their ability to provide their patient with the best care, and their sense of feeling supported.IMPLICATION:Results of this pilot suggest that using live telehealth services for sexual assault forensic examinations is a promising practice.

Background: The majority of studies investigating child pornography have focused on conceptualizing the problem and the harm of the crime, evaluating the risk for child pornography offending, or discuss preventive measures. Little is known about survivors of this type of crime. Objective: This research explores the relationship between child pornography victimization and psychopathology in adulthood. Specifically, we examined the contribution of emotional reactions at the time of the crime and shortly after (guilt, embarrassment and avoidance) on psychopathology among adult survivors of child pornography. Participants and setting: The study was conducted among 107 child pornography adult survivors, aged 18-63 (M = 39.48, SD = 12.31). All participants were sexually molested during the crime. Methods: An online survey was completed by a convenience sample of adult survivors of child pornography. Results: Findings indicate survivor's current age predicted current psychopathology symptoms. Survivor's emotional reactions of guilt and embarrassment at the time of the crime and shortly after were significantly associated with elevated psychopathology, above and beyond demographic characteristics and features of the crime. Conclusions: The present results suggest the way survivors of child pornography react to the crime might shape their mental health in the long term.

This research explores the complex experiences of survivors of child pornography production. The study was conducted among a convenience sample of child pornography adult survivors (N = 133), using an online survey which included a series of open-ended questions. Nearly half of respondents reported that they felt the production of sexual images caused specific problems that were different from the problems caused by other aspects of the abuse. Nearly half of the sample worried all the time that people would think they were willing participants or that people would recognize them, one-third refused to talk about the images and 22% denied there were images. The qualitative analysis identified three major themes which emerged from the survivor's perspective as adults: Guilt and shame, their ongoing vulnerability and an empowerment dimension the images sometimes brought. Recommendations for further research and additional implications are discussed.

The scope of student victimization occurring on college campuses is problematic, drawing the attention of researchers and campus officials. While most researchers of the disclosure of these unwanted experiences tend to examine just 1 form of victimization, a direct comparison of the disclosure of different types of campus victimization within a singular study is missing in the literature. The current study aimed to address this issue by examining 4 types of victimization experiences (unwanted sexual contact, unwanted sexual intercourse, intimate partner violence, and stalking) in a college population. A common set of possible predictors of disclosure were examined, including both demographic (e.g., gender, race, age) and situational factors (e.g., alcohol use, level of fear, relationship with perpetrator). While patterns of similarity across all victimization experiences emerged, the impact of gender, race, age, and alcohol use on disclosure decisions varied substantially by victimization type. The findings of this study address the gap in the current literature by providing a comparison and contrast of the influence of predictors across different types of victimization. Furthermore, the findings provide needed information that could help colleges and universities develop ways to encourage support-seeking and reporting among students.

Victims portrayed in sexual abuse images may be resistant to participate in research because of embarrassment or shame due to the sensitive nature and potential permanency of images. No studies we are aware of explore reactions to participating in research after this type of crime. Telephone interviews were conducted with convenience samples of parents (n = 46) and adolescents who were victims of child sexual abuse (n = 11; some of whom were portrayed in sexual abuse images), and online surveys were completed by adult survivors depicted in abuse images (N = 133). The first lesson was that few agencies tracked this type of crime. This lack of tracking raises the question as to what types of data should be collected and tracked as part of an investigation. The second lesson was that few victims at the two participating agencies had been portrayed in sexual abuse images (4%-5%). The third lesson was that once possible cases were identified, we found relatively high percentages of consent to contact and interview completions. This implies that researchers and service providers should not be hesitant about conducting research after an investigation of child sexual abuse. The fourth lesson was that the vast majority of participants reported not being upset by the questions. We hope that the data presented here will encourage agencies to reconsider the types of data being tracked and will encourage researchers to conduct in-depth research with populations that are often difficult to reach to continue improving the professional response to child victimization.

Purpose: Sextortion (threats to expose sexual images to coerce victims to provide additional pictures, sex, or other favors) has been identified as an emerging online threat to youth, but research is scarce. We describe sextortion incidents from a large sample of victims (n = 1,385) and examine whether incidents occurring to minors (n = 572) are more or less serious than those experienced by young adults (n = 813). Methods: We ran advertising campaigns on Facebook to recruit victims of sextortion, ages 1825, for an online survey. We use cross tabulations and logistic regression to analyze incidents that began when 18- and 19-year-old respondents were minors (ages 17 and younger) and compare them with incidents that began at ages 18- 25 years. Most minor victims were female (91%) and aged 16 or 17 when incidents started (75%). Results: Almost 60% of respondents who were minors when sextortion occurred knew perpetrators in person, often as romantic partners. Most knowingly provided images to perpetrators (75%), but also felt pressured to do so (67%). About one-third were threatened with physical assaults and menaced for >6 months. Half did not disclose incidents, and few reported to police or websites. Perpetrators against minors (vs. adults) were more likely to pressure victims into producing initial sexual images, demand additional images, threaten victims for >6 months, and urge victims to harm themselves. Conclusions: Sextortion incidents were serious victimizations, and often co-occurred with teen dating violence. We describe resources so that practitioners can help victims find support and legal advice and remove posted images. (C) 2017 Society for Adolescent Health and Medicine. All rights reserved.

Child Advocacy Centers (CAC) emphasize developing effective cross-agency collaborations between workers involved in serious abuse investigations to foster improvements in agency outcomes, and to minimize distress, confusion and uncertainty for children and families. This study examined the characteristics of CACs, whether models in practice match the predominant model presented in the research literature. Directors of CACs in the United States that were members of the National Children’s Alliance (NCA) mailing list (n = 361) completed an online survey in 2016. While some core characteristics were ubiquitous across CACs, the data suggests that different types of CACs exist defined by characteristics that are not prescribed under NCA principles, but which are arguably relevant to the quality of the response. From the results of a cluster analysis, the researchers propose a typology of CACs that reflects the development and integration of centers: (a) core CAC services (i.e. interviewing & cross-agency case review); (b) an aggregator of external services, and (c) a more centralized full-service CAC. Further research is needed to understand how these variations may impact practice and outcomes; this is particularly important considering many CACs do not match the full-service models most commonly examined in the research literature, which limits the degree to which these findings apply to CACs generally. This article proposes further research framed by the need to better understand how different parts of the response impact on outcomes for children and families affected by abuse.