[Assessment of a new law for sex offenders implemented in France in 1998]. / Loi du 17 juin 1998 : bilan de l'expérience des médecins coordonnateurs de Haute Normandie.

OBJECTIVES: Most people recognize that incarceration alone will not solve sexual violence. Treating the offenders is critical in an approach to preventing sexual violence and reducing victimization. The Law of June 17, 1998, on the prevention and repression of sexual offences, as well as the protection of minors, makes a provision for the possibility of medical and psychological monitoring adapted to these particular individuals. Sex offenders may well be constrained, after their incarceration, to social and judicial follow-up, which may include coerced treatment in order to reduce the risk of recidivism. In order to control this follow-up, the legislature has created the position of medical coordinator, who acts as an interface between justice and care in conjunction with the treating physician. This study is the first attempt to evaluate the activity of physician coordinators conducted in France since the implementation in 2004 of the 1998 law on monitoring sex offenders. METHODS: An interview of all the physician coordinators in Upper Normandy was conducted. The files of all sex offenders subjected to coerced treatment were studied. RESULTS: In our sample of 100 sex offenders who were subjected to coerced treatment (any kind of treatment) (99% men, 60% of sexual assaults on minors, 14% of cases of indecent exposure), minor victims of sexual assault were: 78% females; in 90% of cases the victim was aged under 14 years (under 10 in 52% of cases), 60% of cases were intrafamilial incest; the victim was an unknown aggressor in only one case out of 60. The constraint follow-up contributed to reducing the risk of recidivism (three cases of recidivism in 100 individuals over an average duration of follow-up of five years), although it remains difficult to assess the recidivism over a duration of time as short as five years. A diagnosis of paraphilia was only applied in 19% of cases (in 10 cases pedophilia, exhibitionism in nine cases). Only six subjects were receiving antiandrogen treatment. A diagnosis based on Axis I DSM was established in 57% of cases. Personality disorders were mentioned in the medical records in 65% of cases. An antisocial personality disorder was not prominent (20%). In 56 cases, the individuals had been victims of physical, psychological or sexual abuse. Nearly half of the individuals had a past history of sexual or non sexual offences, among those, 16 subjects had previously been convicted at least three times. The seniority of the prior conviction was more than 10 years in 43% of cases. Physician coordinators interviewed were satisfied with their work and felt they had contributed to improving the care of patients who had committed sexual offences. CONCLUSION: However, this study shows the need to create a national reference centre, which could enable a multidisciplinary evaluation of difficult cases and could also boost the development of research in this area where many questions remain unanswered, particularly regarding the determinants of deviant sexual behaviour and risk factors for recidivism.

An assessment of outcomes following parents' participation in a child abuse prevention program.

The purpose of this study was to evaluate the outcomes following participation in the ESPACE parents' workshop. A group of 55 parents who participated in the program, implemented in elementary schools in the Quebec city region, was compared to a group of 217 parents who did not attend the prevention workshop. The results revealed that attending parents suggested more adequate interventions to the vignette depicting a hypothetical situation of sexual abuse compared to nonattending parents. Attending parents are found to be more likely to suggest interventions sustaining the child in her own problem-solving process, seek help from specialized agencies, and attempt to offer emotional support to the victim. Data also reveal that the parents workshop has a positive outcome on knowledge. While the workshop is associated with beneficial outcomes, attendance rates are low. The findings are discussed in the context of identifying means to foster parent involvement in the prevention of child abuse.

"Reporting costs" to nonoffending parents in cases of intrafamilial child sexual abuse.

Findings from a study of 104 nonoffending parents and their sexually abused children suggest four areas in which nonoffending parents experience significant change or loss as a result of the disclosure of the sexual abuse of their children. The term reporting cost was coined to describe these changes and losses. The four types of reporting costs found are relational, financial, vocational, and residential. Nonoffending parents experienced an average of three major costs from the disclosure of intrafamilial sexual abuse.

Child sexual abuse by uncles: a risk assessment.

Using a sample of 982 mothers who reported on child care and living arrangements involving uncles, and case records documenting the sexual abuse of 171 children by 148 uncles, this study examined the ways uncles ordinarily become involved with children, the conditions under which that involvement becomes associated with sexual abuse, and the role gender plays in this dysfunction. Among the findings, it was noted that although aunts were responsible for 28 times more child care than uncles, uncles were responsible for 48 times more child sexual abuse. Although female children do not have more exposure to uncles than do males, they appeared four times more likely to be victimized. About 19% of the abusive uncles lived with the children they abused, and most of the remainder came into contact with them as child care providers or during overnight visits. Implications for practice are discussed.