Medical examination of sexually abused children: medico-legal value

The Department of Forensic Medicine (forensic pathology and clinical forensic medicine), Aarhus, Jutland, Denmark, performs examinations of children suspected to have been sexually abused when reported to and requested by the police in Jutland, Denmark. Jutland covers an area of 210,000 km2 with about 300,000 inhabitants in Aarhus. A colposcope initially equipped with an Olympus camera, but now with a video camera attached has been used since 1994. Since 1994 the department has performed more than 100 examinations of children suspected of having been sexually abused. A preliminary study was taken to evaluate all cases from 1995 including the legal outcome. RESULTS: The material included 34 cases with three boys, mean age 11 years, and 31 girls, mean age 8 years, at the time of the examination. The sexual abuse events were fondling including penetration of the vagina, vaginal (14), anal (7), and oral (5) intercourse as well as cunnilingus and nontouching abuses. The medical examination was most often performed more than a week after the abuse. The examination revealed normal findings in 23 cases, nonspecific findings including erytherma in 13 cases, and in only one child was a traumatic lesion with rupture of the hymen seen. The perpetrators were above 25 years of ane and were family members or someone known to the child. Nine perpetrators were convicted at court, of whom three admitted having abused the child. CONCLUSION: A medical examination in cases of sexual child abuse seldom provides a legal proof of sexual abuse. The most important is the story told by the child. Therefore, the examination is a supplement which may support or remain neutral to the story told by the child.     

Alcohol Use,Drinking Venue Utilization,and Child Physical Abuse: Results from a Pilot Study

A positive relationship between parents’ drinking and child physical abuse has been established by previous research. This paper examines how a parent’s use of drinking locations is related to physical abuse. A convenience sample of 103 parents answered questions on physical abuse with the Conflict Tactics Scale-Parent Child version (CTS-PC), current drinking behavior, and the frequency with which they drank at different venues, including bars and parties. Ordered probit models were used to assess relationships between parent demographics, drinking patterns, places of drinking, and CTS-PC scores. Frequent drinking, frequently going to bars, frequently going to parties in a parent’s own home, and frequently going to parties in friends’ homes were positively related to child physical abuse. The number of drinking locations was positively related to child physical abuse such that parents who report attending and drinking at more of these venues were more likely to be perpetrators of physical abuse. This suggests that time spent in these venues provides opportunities to mix with individuals that may share the same attitudes and norms towards acting violently.     

Societal views of justice for adolescents accused of murder

Examines citizens' views about when juveniles accused of homicide should be tried and punished as adults. Responses from two randomly selected samples of adult Georgia residents suggest that these views are strongly influenced by whether adolescent defendants have been victims of abuse. Laypersons prefer juvenile court for juveniles who kill abusive parents (76% for first time offenders. 77% for those with one prior adjudication). Respondents are split concerning how to punish abused juveniles who have two prior adjudications (49% recommend juvenile court) and abused juveniles with one prior offense who kill a neighbor (48% recommend juvenile court). Most respondents, however, prefer adult court for repeat offenders who kill and have no history of child abuse. These findings suggest that legislative automatic transfers are overly simplistic compared to the contextual sensitivity of community sentiment. Policymakers may have serious misconceptions of societal views of fairness in this area.     

PROBLEMS AND SOLUTIONS IN THE MANAGEMENT OF CHILD ABUSE ALLEGATIONS IN CUSTODY AND ACCESS DISPUTES IN THE FAMILY COURT

Child abuse allegations in custody and access disputes are serious matters and present family courts worldwide with major problems. This article reports a large research study just completed that investigated the way the Family Court of Australia managed child abuse cases. The study showed that such cases had become a substantial part of the court's current workload, their "core business" in fact. The families involved had many difficulties, including a history of family violence, and the present system was not appropriate for their particular problems. Thus, as new specialized court lead model of intervention was devised, based on principles relevant to family violence and incorporating the most effective strategies identified in the research.     

GENDER BIAS IN CHILD CUSTODY DECISIONS

Throughout history, gender stereotypes have played a key role in child custody dispositions. Despite current gender-neutral statutes, men's advocacy groups claim that custody decisions continue to discriminate against fathers. Women's advocacy groups and the media counter that custody decisions discriminate against mothers. Contradictory perceptions can be traced to the imprecision of the best interest standard, anecdotal cases that have been popularized in the media, a selection bias among cases that are decided in court, the absence of reliable nonpartisan research, distortions of existing research, and implicit assumptions about which parent should get custody. Gender stereotypes that favor mothers' preferential claims to custody are not supported by research, and the primary parent presumption is regarded as seriously flawed. Rather than focus on the demands of adults, custody reform should address the needs of children.     

The incidence of alleged sexual abuse in 603 family court cases

The conflict and animosity that sometimes accompanies child custody disputes can give rise to the propagation of allegations of child sexual abuse. To characterize the magnitude of the problem, the present study attempted to determine whether and to what extent child sexual abuse allegations predominate in family court litigation. The entire one-year caseload of a county family court docket was systematically reviewed and coded. Methodical evaluation of 603 family court files yielded base rates of pertinent allegations and other information profiling the cases. The findings did not support the contention that sexual abuse allegations are commonplace in child custody disputes. Sexual abuse allegations were made in 2% of cases in which custody or access was contested and in only 0.8% of the cases overal. Implications of the findings for future research were discussed.The authors gratefully acknowledge the assistance of the Honorable William R. Campbell and Barbara Scott, Clerk of Court for the South Carolina Fifth Judicial Circuit, as well as the contributions of Angie Newton, Frank Robinson, and Kimberly Ellis in the data collection process.     

EMPIRICAL ANALYSIS OF REFERRAL ISSUES AND “ULTIMATE ISSUE” RECOMMENDATIONS FOR PARENTS IN CHILD PROTECTION CASES*

Mental health professionals frequently respond to requests for clinical information on parents in child protection cases; however, little data exist on the issues precipitating requests or on the controversial practice of offering “ultimate issue” recommendations in forensic clinical reports. We investigated 243 requests for clinical information on parents and 204 clinician reports submitted for use in child abuse and neglect proceedings in a large, urban juvenile court system. We coded 56 objective and qualitative characteristics regarding referral questions, pending legal issues, and four levels of recommendations. We found that the most common referral questions related to service planning, parenting ability, and/or parents' mental health functioning, and the most common pending legal issues were selection or change of a permanency goal and visitation arrangements. Levels of recommendations varied with type of legal decision, in that clinicians always offered direct recommendations for narrow, statute‐based issues (e.g., termination of rights, adoption) and less so for other issues. Community‐based evaluators were more likely to offer direct recommendations than court‐based clinicians. Based on the findings, we offer practice recommendations and directions for further research in forensic parenting assessment.     

Child abuse reporting trends: an unprecedented threat to confidentiality

Some recent interpretations of the child abuse laws are creating serious and unprecedented erosions of therapist/patient confidentiality. In contrast to the Tarasoff decisions and laws, the child abuse statutes introduced a new element of mandatory reporting which permits no discretionary alternatives and presents prospects of criminal penalties for failure to report. A recent development suggests a possible requirement for therapists to violate confidentiality for the sole purpose of punishing perpetrators. Overinterpretations of the laws by some child protective services have led to recommendations that long past child abuse must be reported, even when no current child is in danger. The California Attorney General's Office has issued a clarification stating that the child abuse statute refers to children and not to adults molested as children. A survey of forensic psychiatrists and psychologists shows that most perceived an ethical problem in reporting adults molested as children when no child is presently in danger, and the purpose of the report is solely for maximal legal self-protection. The survey indicates that fears induced by rigid and intimidating child abuse laws can influence therapists to act in ways most consider unethical. Recommendations are made for improving the current child abuse laws so that they accomplish their goals more effectively.     

ALLEGATIONS AND SUBSTANTIATIONS OF ABUSE IN CUSTODY‐DISPUTING FAMILIES1

In this study of 120 divorced families referred for child custody evaluations and custody counseling, multiple allegations of child abuse, neglect, and family violence were raised in the majority of cases. About half of the alleged abuse was substantiated in some way with one fourth involving abuse perpetrated by both parents. Different kinds of allegations were raised against mothers compared with fathers. Implications of these findings for social policy, family court interventions, and the provision of coordinated services within the community are discussed.     

Fatal child neglect in West Germany 1 January 1985 to 2 October 1990. Results of a multicenter study]

Up to now reliable data were available on cases of lethal child neglect in the area of the Federal Republic of Germany prior to reunification (the former West Germany). In a multicenter study we therefore examined the police and court records for such cases occurring in the period from 1 January 1985 to 2 October 1990 in nearly the entire area of Federal Republic of Germany. RESULTS: The study center received information on 19 cases of lethal child neglect. Extrapolated to all institutes of legal medicine, this corresponds to 20 cases and thus 3.5 cases a year in the whole of West Germany in the period studied. There is to be added a dark-field which cannot be limited more precisely. However, the cases of fatal child neglect might have occurred much more seldom than fatal child abuse caused by use of physical violence. Slightly more than half the victims were younger than 1 year, the oldest one was 7 10/12 years old. Most frequently the children died of starvation and thirst. Mostly the mothers/nursing mothers killed the child alone or together with the victim's father/stepfather. In the majority of the cases there was not a close affection between parents and child. Nearly 30% female/male perpetrators suffered from chronic alcohol abuse. Only 15 (= 56%) of 27 female/male perpetrators were sentenced to imprisonment (period between 7 months on probation and 10 years). Mitigation circumstances existed for nearly half the persons sentenced to imprisonment. It is true that child neglect is a rarer crime, but the experts of legal medicine always have to indicate errors made during the external inspection of the corpse (among others failures to see indications of neglect).     

Hardened professional criminals,or just friends and relatives? The diversity of offenders in human trafficking

ABSTRACT

Human trafficking has been extensively discussed, studied and debated over the past 20 years, but many misleading images and stereotypes still exist regarding trafficking, its victims and its perpetrators. Trafficking is often framed as a problem of organised crime. The article problematises (1) the stereotypical images of perpetrators and (2) the involvement of organised crime in human trafficking, particularly in Finland, drawing on court cases that deal with trafficking in human beings. The article analyses, on the one hand, the characteristics of detected traffickers by reflecting the findings against the image of the ideal offender and, on the other hand, the role and involvement of organised crime in human trafficking. The article concludes that most convicted traffickers are not so-called ideal offenders. The variety of traffickers involved in the cases studied does not correspond very well to the rather stereotypical and oversimplified image of traffickers and ideal offenders.     

Legal Outcomes of Suspected Maltreatment Cases Evaluated by a Child Abuse Pediatrician as Part of a Multidisciplinary Team Investigation

Child abuse pediatricians often carry the stigma that their sole role is to diagnose maltreatment. In reality, child abuse pediatricians use their clinical experience and current evidence-based medicine to make the best medical diagnoses for the children they evaluate. To better understand the legal conclusion of suspected maltreatment cases with medical examinations, this study sought to: (i) evaluate the percentage of children seen for suspected maltreatment that led to a clinical diagnosis of maltreatment, (ii) determine the number and type of criminal charges associated, and (iii) analyze the legal outcomes of cases as they proceeded through the judicial system. This study retrospectively reviewed the legal outcomes of 1698 children medically evaluated in 2013–2014 as part of an investigation by a multidisciplinary team at a children’s advocacy center in a mid-sized city in Oklahoma. Data were collected from electronic medical records, the district attorney’s office, and a public court docket. Of the original cohort, 477 (28.09%) children yielded a medical diagnosis of at least one type of maltreatment. Further analysis yielded 115 unique court cases involving 138 defendants and 151 children. A total of 286 charges were filed resulting in 190 convictions. While maltreatment allegations yield a high number of children that must be evaluated, a comprehensive medical evaluation helps determine which cases do not have sufficient medical findings for a diagnosis of maltreatment. The findings in this study indicate that a majority of suspected maltreatment cases seen by child abuse pediatricians did not result in criminal court outcomes.     

Situational factors in female-perpetrated child sexual abuse in organisations: implications for prevention

ABSTRACT

Despite increasing interest in child sexual abuse occurring in organisations, the perpetration of such abuse by females is largely ignored. This study examined situational factors in 136 cases of sexual abuse perpetrated by women working with children in the UK, Canada and the USA between 2000 and 2016. Qualitative and quantitative content analysis of court reports, professional regulator decisions, media reports and an online sentencing database was used, findings indicating that situational and contextual factors are highly relevant in perpetration. Much abuse occurs away from the organisational environment, particularly in perpetrators’ homes and cars, and in virtual environments. However, it also occurs within organisations, generally in unsupervised areas, outside of operating hours and often during mentoring/tutoring or extra-curricular activities. Organisational and local culture can be a facilitator in this abuse and allow it to continue even when concerns are raised. Practical prevention measures are suggested to assist in reducing future abuse.     

The approach in Scotland to child contact disputes involving allegations of domestic abuse

ABSTRACT

This article considers the approach taken in Scotland to the processing of child contact cases in which there are allegations of domestic abuse. Four key features of the processing of cases which may facilitate outcomes that prioritise safety are considered. These are: the availability of legal aid; the cautious process of successive child welfare hearings; the use of child welfare reports; and the taking of the child’s views. All these features occur within a policy context that recognises domestic abuse as gender-based violence and where courts have a statutory duty to protect a child from abuse. Drawing on the author’s court based analysis of papers from 208 child contact disputes and from interviews with sheriffs, this article discusses the strengths and limitations of all four process features in terms of protecting women and children, and the risks to these features posed by perpetually reducing government budgets.     

Gender-Role Stereotypes and Perceptions of Heterosexual,Gay and Lesbian Domestic Violence

Although domestic violence occurs in all types of relationships, non-prototypical cases (e.g., gay male, lesbian, female-against-male) are often overlooked. We replicated and extended previous research demonstrating that perceptions of heterosexual and same-sex domestic violence are generally consistent with gender-role stereotypes. Male and female undergraduates read one of four domestic abuse cases varying by victim and perpetrator sex and sexual orientation. Victim sex, ratherthan sexual orientation, was the most potent predictor of responses, although male-against-female violence was considered the most serious and deserving of active intervention. Domestic violence perpetrated by men or against women was judged more serious than violence perpetrated by women or against men. Perceptions that male perpetrators were more capable of injuring victims, and female victims were more likely to suffer serious injury were consistent with gender-role stereotypes.     

ASSESSING AND MANAGING ALLEGATIONS OF CHILD SEXUAL ABUSE

This article examines the procedures involved in the assessment and management of allegations of child sexual abuse in courts exercising custody and access jurisdictions. The author discusses the various options available to the court when confronted with such allegations, noting that, in the contex: of access disputes, the issue for the court is not whether a parent has sexually abused a child but whether, in all the circumstances of the case, access should take place or custody should change. In all matters involving access between parents and children, the overriding principle is the paramountcy of the welfare of the child. It is also argued that supervised access, although an increasingly popular alternative for the court when faced with allegations of abuse, is problematic and may not be in the best interests of the child. The author suggests that the emphasis must be on children's rights find parental responsibilities.     

PUBLIC OPINION AND THE FOUNDATION OF THE JUVENILE COURT*

Over 100 years ago, juvenile courts emerged out of the belief that juveniles are different from adults—less culpable and more rehabilitatable—and can be "saved" from a life of crime and disadvantage. Today, the juvenile justice system is under attack through increasing calls to eliminate it and enactment of statutes designed to place younger offenders in the adult justice system. However, little evidence exists that policy makers have taken the full range of public views into account. At the same time, scholarly accounts of calls to eliminate the juvenile justice system have neglected the role of public opinion. The current study addresses this situation by examining public views about 1) abolishing juvenile justice and 2) the proper upper age of original juvenile court jurisdiction. Particular attention is given to the notion that child‐saving and "get tough" orientations influence public views about juvenile justice. The analyses suggest support for the lingering appeal of juvenile justice among the public and the idea that youth can be “saved,” as well as arguments about the politicization and criminalization of juvenile justice. They also highlight that the public, like states, holds variable views about the appropriate age of juvenile court jurisdiction. We discuss the implications of the study and avenues for future research. Why is it not just and proper to treat these juvenile offenders, as we deal with the neglected children, as a wise and merciful father handles his own child whose errors are not discovered by the authorities? Why is it not the duty of the state, instead of asking merely whether a boy or a girl has committed a specific offense, to find out what he is, physically, mentally, morally, and then if it learns that he is treading the path that leads to criminality, to take him in charge, not so much to punish as to reform, not to degrade but to uplift, not to crush but to develop, to make him not a criminal but a worthy citizen.     

HIGH‐CONFLICT CONTACT DISPUTES: EVIDENCE OF THE EXTREME UNRELIABILITY OF SOME CHILDREN'S ASCERTAINABLE WISHES AND FEELINGS

This article challenges an increasing orthodoxy regarding the weight which courts might place upon the expressed views of children in a specific situation—high‐conflict contact disputes. I am a child psychiatrist who acts as an expert witness within the family courts of England & Wales. I have conducted a statistical analysis of cases in which I have conducted assessments of children caught in such disputes between their separated parents. Fifty‐eight children met the criteria for inclusion in the study—the child's consistent opposition to contact with the non resident parent (NRP), despite the court having determined that there was no good reason to constrain contact. My assessment routinely included attempted observation of the child at a visit with the NRP. Despite their stated views most children had a positive experience in those visits that took place, and despite the fact that most had not seen the NRP for a long time. Overall there was a statistical association between increased resistance to contact and the greater age of the child and the longer the time during which no contact had occurred. However, the responses of children and young people were unpredictable and it was impossible to conclude that apparent maturity or intelligence was a guide to the reliability of their expressed resistance. The possible reasons for this unreliability are discussed. I emphasize that my sample of children is unusual as many of the cases had involved serious, though unfounded, allegations of abuse. In addition most of the children showed indications of having become “alienated” from the NRP. I conclude that courts might exercise caution when evaluating the views of children and young people in this situation, and emphasises that assessors should consider including at least one observation of the child at a prolonged visit to the NRP. Because of the new orthodoxy some parents may be tempted to misuse their child's right to a “voice” in court in order to achieve their own ends. Practitioners who advise courts may need to be more aware of these difficulties.