Paediatric health care in the #MeToo era: Advocating for survivors of sexual violence.

We are witnessing a momentous cultural shift in how we understand, respond to, and resist sexual violence. Rise of the #MeToo movement has ignited a viral wave of consciousness raising, dialogue, and advocacy on an international scale. Women and girls have been empowered to share their stories of sexual assault, bringing to light the widespread prevalence of gender-based violence. As the shame and blame that have silenced victims gradually diminish, we anticipate a continued upward trend in sexual assault disclosure among youth, and corresponding increase in demand for trauma-informed paediatric sexual assault services. It is our collective responsibility to prevent revictimization and retraumatization by the very systems designed to help. In this critical lens commentary, we strongly advocate for heightened awareness and improved responsiveness among paediatric health care providers and policymakers to effectively and ethically meet the diverse needs of the growing number of young survivors who take the brave step of speaking out and reaching out.

From Freud to Feminism: Gendered Constructions of Blame Across Theories of Child Sexual Abuse.

Most theories of child sexual abuse are, to some degree, gendered, with nonoffending mothers bearing the burden of blame, ideologically and legally, for the transgressions of predominantly male offenders. This article explores the social construction of blame for child sexual abuse via critical analyses of evolving theoretical perspectives on maternal culpability for the inception and maintenance of abuse dynamics. Drawing on selected conceptual and research knowledge that supports and refutes anecdotal claims, this synthesis of the literature culminates in the proposal of an evidence-informed, feminist-grounded, multitheoretical child sexual abuse framework that disrupts dominant mother-blaming discourse and guides socially just and ethically responsive policy, practice, and research.

Gendered Attributions of Blame and Failure to Protect in Child Welfare Responses to Sexual Abuse: A Feminist Critical Discourse Analysis.

Gender-based relations of power and attributions of blame for child sexual abuse have been longstanding in child welfare policy and practice. Nonoffending mothers continue to be ascribed responsibility through the ideologically and institutionally entrenched doctrine of failure to protect. Feminist critical discourse analysis was used to (a) expose and disrupt dominant discourses of gender, motherhood, and risk that operate to construct and reinforce notions of blame and failure to protect, as enacted by way of child welfare text in context; and (b) build a credible case for social and organizational change grounded in an alternative discourse with greater explanatory power. Progressive avenues for resistance, negotiation, and transformation are proposed.

Child Welfare System Involvement Among Children With Medical Complexity.

Children with medical complexity may be at elevated risk of experiencing child maltreatment and child welfare system involvement, though empirical data are limited. This study examined the extent of child welfare system involvement among children with medical complexity and investigated associated health and social factors. A retrospective chart review of children with medical complexity (N = 208) followed at a pediatric hospital-based complex care program in Canada was conducted. Descriptive statistics and odds ratios using logistic regression were computed. Results showed that nearly one-quarter (23.6%) had documented contact with the child welfare system, most commonly for neglect; of those, more than one-third (38.8%) were placed in care. Caregiver reported history of mental health problems (aOR = 3.19, 95%CI = 1.55-6.56), chronic medical conditions (aOR = 2.86, 95%CI = 1.09-7.47), and interpersonal violence or trauma (aOR = 17.58, 95%CI = 5.43-56.98) were associated with increased likelihood of child welfare system involvement, while caregiver married/common-law relationship status (aOR = 0.35, 95%CI = 0.16-0.74) and higher number of medical technology supports (aOR = 0.75, 95%CI = 0.57-0.99) were associated with decreased likelihood. Implications for intervention and prevention of maltreatment in children with high healthcare needs are discussed.

A meta-analysis of the prevalence of child sexual abuse disclosure in forensic settings.

BACKGROUND: Identification, substantiation, prosecution, and treatment of child sexual abuse often rely heavily on a disclosure from the victim in the absence of corroborating evidence. For some, disclosure can be impeded by developmental or motivational barriers, thus compromising child safety and wellbeing. The literature on disclosure prevalence and mitigating influences does not yield a coherent picture. A more accurate estimate will help to inform investigation strategies to facilitate disclosure. OBJECTIVE: This study provides a meta-analysis of available research examining the prevalence of sexual abuse disclosure in forensic interviews with children under 18 years, and examines a range of factors that may influence the likelihood of disclosure. METHOD: Databases were searched for published and unpublished studies up to May 2017. In total, 2393 abstracts were assessed for eligibility, 216 full-text articles were reviewed, and 45 samples (with 31,225 participants) provided estimates of effect sizes. RESULTS: The mean prevalence of child sexual abuse disclosure in forensic settings was 64.1% (95% CI: 60.0-68.1). Between-study variability was explained by: (1) child age and gender, with higher prevalence in older children and females; (2) prior disclosure, with higher prevalence when present; and (3) study year, with higher prevalence in more recent studies. CONCLUSIONS: This meta-analysis confirms an upward trend in child sexual abuse disclosure prevalence. However, more than a third of children do not disclose when interviewed, with those who are younger, male, and without a prior disclosure at greatest risk. Important implications for forensic interviewing protocols and future research are discussed.

The Prevalence of Unwanted Online Sexual Exposure and Solicitation Among Youth: A Meta-Analysis.

PURPOSE: The objective of this meta-analysis was to provide a synthesis of studies examining the prevalence of unwanted online exposure and solicitation of a sexual nature among youth, and to determine if prevalence varies by youth age, gender, year of study data collection, or study geographical location. METHOD: Eligible studies from January 1990 to January 2016 were identified utilizing a comprehensive search strategy. Included studies examined the prevalence of unwanted online exposure and solicitation in youth who ranged from 12 to 16.5 years. Two independent coders extracted all relevant data. Random-effects meta-analyses were used to derive mean prevalence rates. RESULTS: Thirty-one (37,649 participants) and nine (18,272 participants) samples were included in the syntheses on unwanted online sexual exposure and solicitation, respectively. For online exposure, the mean prevalence rate was 20.3% (95% confidence interval: 17.1-23.4). For online solicitation, the mean prevalence rate was 11.5% (95% confidence interval: 9.4-13.6). Moderator analyses indicated that prevalence rates for unwanted online exposure and solicitation have decreased over time. Prevalence varied as a function of gender (solicitations were higher for males), but not age or geographical location. CONCLUSIONS: Approximately one in five youth experience unwanted online exposure to sexually explicit material and one in nine youth experience online sexual solicitation. Educational campaigns to raise awareness of Internet risks and safety strategies are warranted.

Medical nonadherence in pediatric HIV: psychosocial risks and intersection with the child protection system for medical neglect.

Nonadherence to antiretroviral treatment has serious health implications for HIV-infected children, at times warranting referral to child protective services (CPS). The current study of 134 children with perinatally acquired HIV infection aimed to investigate rates of treatment adherence and CPS involvement, multilevel variables associated with nonadherence, and the manner in which these risks operated together in the prediction of adherence outcomes. Risk factors for nonadherence were grouped on the basis of confirmatory factor models, and factor score regression was carried out to determine which factors were uniquely predictive of adherence. A series of indirect effects models were then tested in order to examine how these factors operated together in the prediction of adherence. Results showed that almost half of the sample demonstrated suboptimal adherence to treatment, and in one-fifth, CPS was involved for medical neglect. Caregiver Health, Caregiver Involvement, Caregiver Acceptance, and Child Adaptation were predictive of nonadherence, and together explained 54% of the variance in treatment adherence. There were significant indirect effects of Caregiver Health on adherence that operated through Caregiver Involvement and Child Adaptation and an indirect effect of Caregiver Involvement on adherence through Child Adaptation. Findings extend current literature that has independently linked various factors predictive of medical adherence in pediatric HIV by showing separate but simultaneous associations with nonadherence and unique pathways to adherence involving multilevel risks. Healthcare and child welfare implications are discussed.