Detecting child sexual abuse in child and adolescent psychiatry: a survey study of healthcare professionals' assessment practice.

BACKGROUND: Research shows that only around half of all survivors of child sexual abuse (CSA) disclose the abuse during childhood and adolescence. This is worrying, as CSA is related to substantial suffering later in life. The proportion of children and adolescents who have been exposed to CSA is significantly higher in Child and Adolescent Psychiatry (CAP) than in the general population. Healthcare professionals report that uncovering CSA is a complex and challenging task. However, we know little about how they proceed when uncovering CSA. More knowledge of healthcare personnel's experience is therefore necessary to facilitate and increase CSA disclosure. The study aims to explore how CAP healthcare professionals in Norway proceed when assessing and detecting CSA, how they experience this work, and what hinders or facilitates their efforts. METHODS: The study employed a mixed method approach. Data was collected through an anonymous online survey, generating both quantitative and qualitative data. The sample consisted of 111 healthcare professionals in CAP, of whom 84% were women, with a mean age of 40.7 years (range 24-72; sd = 10.8). Mean years of CAP clinical experience were 8.3 years (range 0-41; sd = 7.5). The quantitative data was analysed using descriptive statistics, correlations, and independent sample t-tests, while the qualitative data was analysed using a team-based qualitative content analysis. RESULTS: The results showed that detection of CSA was viewed as an important, but complex task in CAP, and the existing procedures were deemed to be insufficient. The therapists mostly felt confident about how to proceed when they suspected or detected CSA, yet they seldom detected CSA. In their initial assessment they applied standardised procedures, but if their suspicion of possible CSA persisted, they seemed to rely more on clinical judgement. Specific challenges and facilitators for CSA detection were identified, both in the individual and in the organisation. CONCLUSIONS: The study highlights the challenges and complexities healthcare professionals and the CAP system face when assessing CSA, which may account for the low detection rate. The results show that healthcare professionals believe room for clinical autonomy and targeted competence development may improve CSA detection. Additionally, the findings suggest a need for CAP to define roles and responsibilities within and between agencies.

Possible paths to increase detection of child sexual abuse in child and adolescent psychiatry: a meta-synthesis of survivors' and health professionals' experiences of addressing child sexual abuse.

BACKGROUND: Efforts are directed both towards prevention and early detection of Child sexual abuse (CSA). Yet, only about 50% of CSA survivors disclose before adulthood, and health professionals rarely are the first disclosure recipients. Increasing the detection rate of CSA within the context of Child and Adolescent Psychiatry (CAP) therefore represents a significant secondary prevention strategy. However, facilitating CSA disclosure when the survivor is reluctant to tell is a highly complex and emotionally demanding clinical task. We therefore argue that efforts to increase detection rates of CSA within CAP need to rest on knowledge of how both survivors and health professionals experience addressing CSA. METHOD: Using meta-ethnography as method, we present separate sub-syntheses as well an overarching joint synthesis of how survivors and health professionals experience addressing CSA. RESULTS: Results show how both survivors and health professionals facing CSA disclosure feel deeply isolated, they experience the consequences of addressing CSA as highly unpredictable, and they need support from others to counteract the negative impact of CSA. CONCLUSION: The results indicate that adapting the organization of CAP to knowledge of how the survivors and health professionals experience addressing CSA is critical to facilitate earlier disclosure of CSA within CAP.

What Do Survivors of Child Sexual Abuse Believe Will Facilitate Early Disclosure of Sexual Abuse?

The purpose of this study was to explore what adult survivors of child sexual abuse (CSA) believe will facilitate early disclosure of sexual abuse. We conducted semi-structured interviews with 12 adult survivors of CSA aged 18-57 years, and analyzed the transcripts using reflexive thematic analysis. Our analysis resulted in three main themes: Adults making it possible to tell; Adults daring to consider the unthinkable; and Conveying knowledge of CSA that facilitates understanding. The findings highlighted the importance of adults facilitating disclosure and making it possible for survivors to tell about their experiences, but also the responsibility adults have to dare to consider the possibility of CSA when children struggle. Another important finding was the significance of enhancing the general population's understanding of the complexity of CSA, including why disclosure is difficult, so adults are given the tools needed to understand and know what to do when they suspect CSA. The findings also have important implications for the planning and implementation of interventions to facilitate early disclosure of CSA.

Pathways to Understanding - How Adult Survivors of Child Sexual Abuse Came to Understand that they had been Sexually Abused.

While child sexual abuse is recognized as a global challenge in need of attention, all too often it takes years before sexual abuse is disclosed. We therefore need to understand more of the process leading to disclosure of child sexual abuse. The purpose of this study was to investigate how adult survivors of child sexual abuse came to understand that they had been sexually abused. We conducted semi-structured interviews with 8 women and 3 men (18-57 years old) and analyzed the interview transcripts using a hermeneutic-phenomenological approach to thematic analysis. Our analysis resulted in three main themes: The ambiguity of memory: "To remember the catastrophic"; The language of the body: "Let the body speak"; and Encountering an observant other: "The significance of being seen and recognized". The findings highlighted the complexity of the individual process of understanding that one has been sexually abused. The availability and intrusiveness of traumatic memories, bodily sensations and symptoms, and encounters with others proved to be contributing factors in the process. The findings give insights into why disclosure of sexual abuse can be difficult and have important implications for health professionals and policy makers working to help victims of child sexual abuse.