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.     

Self-injurious behaviors, PTSD arousal, and general health complaints within a treatment-seeking sample of sexually abused women

Eighty-nine adult female survivors of childhood sexual abuse, presenting for psychological treatment, were assessed for self-reported rates of self-injurious behaviors (SIB), health complaints, and posttraumatic stress disorder (PTSD) symptoms of physiological arousal. A composite measure of current SIB was significantly and positively associated with health complaints, PTSD arousal, and three measures of sexual abuse severity: age of onset for sexual abuse, injury experienced during the sexual abuse, and perceived life threat. Tests of mediation revealed that symptoms of PTSD arousal mediated the relationship between earlier age of onset for sexual abuse and SIB. PTSD arousal moderated the relationship between sexual-abuse-related injury and SIB. SIB was a unique predictor of health complaints, even after controlling for sexual abuse severity and PTSD arousal.     

Child Medical Evaluation Program: a statewide system for the medical and mental health evaluation of abused and neglected children

The Child Medical Evaluation Program examines 1500 children per year suspected by county social service departments of having subtle physical evidence of abuse or neglect. The program utilizes private practitioners, primarily pediatricians, in a systematic manner and provides consultation, direction, and quality control. The system is a unique, cooperative effort between private practitioners and county departments of social service. It is administered from a state university department of pediatrics. The cost is low, government involvement minimal, and the service extensive. The system is recommended to other states.     

Medical/health histories and physical evaluation of physically and sexually abused child psychiatric patients: A controlled study

This study examines findings from a pediatric health history and child physical examination conducted for 105 outpatient and 105 inpatient children who were classified on the basis of their history of physical and sexual abuse. Based on multivariate and univariate analyses, physically abused children had more early developmental delays, neurologic soft signs, serious physical injuries, skin markings and scars, and stimulant drug use than their non-physically abused peers. Sexually abused children were reported to exhibit higher levels of sexual activity and stimulant drug use, and had more physical signs of genital manipulation than non-sexually abused children. These data highlight the need to further examine the impact of medical and developmental aberrations, the nature and origins of recurrent physical injuries in this population, and the extent of risk-taking in understanding the differences between physical and sexual child maltreatment.     

The stop and think group: Changing sexually aggressive behaviour in young children

Abstract

Until recently, relatively little attention has been paid to young children who are sexually aggressive to other children. In this paper, cognitive-behavioural group techniques which have been used in the treatment of aggressive, impulsive behaviour in young children were applied in a small group setting to the sexually aggressive behaviour of pre-pubescent boys. The boys initially learned a ‘Stop and Think” model for general interpersonal problem-solving, which was then used to work on their difficulties with verbal and physical sexual aggression. Observation of the children's behaviour, reports from carers, school staff and social workers indicated that the group programme increased the children's ability to inhibit impulsive, aggressive behaviour. In the nine months after the group finished there were no known incidents of sexual aggression. In the context of certain limitations discussed in the paper, this positive outcome suggests that these methods have potential for reducing the likelihood of sexually aggressive behaviour becoming habitual.     

Community services for abused women: A review of perceived usefulness and efficacy

This review of 12 studies examines both the types of community and professional services that abused women most frequently contact, and how useful and effective the women perceive those services to be. These studies show that police, social service agencies, clergy, crisis lines, physicians, psychotherapists, women's groups, and lawyers are the sources of assistance abused women most frequently contact. However, the studies reveal that some of these services are not necessarily perceived as very useful or effective. Women tend to contact different services depending on the type of abuse suffered. Abused women report that crisis lines, women's groups, social workers, psychotherapists, and physicians are helpful most of the time for all types of abuse, and that police officers, lawyers, and clergy are not helpful in most types of abuse. Results of this review suggest the need for education of professionals and community service providers in understanding needs of abused women.     

Substance use,health, and mental health: problems and service utilization among incarcerated women

This article profiles self-reported substance use, health, and mental health problems among a sample of incarcerated women in Kentucky as well as lifetime service utilization. Findings indicate that a high percentage of women reported use of alcohol, cocaine, and multiple substances during the month before incarceration. In addition, participants reported common health problems such as dental, female reproductive, physical injuries, and mental health problems including depression and anxiety. Participants reported moderate use of emergency room and mental health treatment but limited substance abuse treatment utilization. Implications for criminal justice programs and linkages with community-based aftercare services for women are recommended based on findings that health and mental health problems are associated with service utilization before incarceration.     

Interventions with women offenders: a systematic review and meta-analysis of mental health gain

Currently, a conjunction of policy, legislative change in health and social care and the criminal justice system, combined with funding for innovative services make it opportune to assess the evidence base for interventions with women offenders. Women offenders have a distinctive criminological, health and social profile and a gender specific approach to their difficulties is advocated. This systematic review and meta-analysis focus on mental health gain in adult women offenders in forensic health settings, criminal justice institutions and in the community, following therapeutic interventions. Interventions were assessed in terms of specific outcome measures of depression, trauma symptomatology and global mental health status. Comprehensive search strategies yielded 3018 articles, from which we obtained 199 full text articles. Seventeen articles were included in the final review, of which six were excluded from the meta-analysis as there was no comparator group. There is a modest, but increasing, body of evidence for the utility of some interventions, notably those addressing the consequences of earlier trauma, including interventions which also address comorbid substance misuse. This does not amount, to date, to a robust evidence base. Limitations of these studies are discussed and include small sample sizes, their restriction mainly to prison populations and that they were substantially undertaken in the US. Variations in outcome measures follow-up and the difficulties inherent in measuring change in this complex population are also detailed. However, the review delineates definite avenues for further work. To achieve this, those responsible for policy, practice and purchase of services should both be mindful of existing evidence and promote additional, high quality research into interventions which are designed around a coherent, theoretical approach.     

Community mental health and prisons: A model for constitutionally adequate care in correctional mental health

The establishment of judicially acceptable standards of mental health care within a prison setting requires the adoption of a service-delivery model and a constant evaluation of that model in relation to individual and civil rights. This article reviews the experience of the department of corrections in one state in developing a constitutionally adequate mental health system. The report outlines the programs established, the legal basis for decisions, and recent constitutional challenges. Future trends in correctional mental health are also discussed.     

Music therapy for improving mental health problems of offenders in correctional settings: systematic review and meta-analysis

Objectives

The aim of this review was to assess the effectiveness of music therapy on improving the mental health of offenders in correctional settings.

Methods

Multiple databases and journals were searched to identify randomized controlled trials and quasi-randomized controlled trials of music therapy for offenders in correctional settings.

Results

Five studies (n?=?409; predominantly male) were included in random-effects meta-analyses. Music therapy was effective for promoting offenders’ self-esteem (Hedges’ g?=?0.55, p?<?0.001) and social functioning (g?=?0.35, p?<?0.05). Effects on anxiety and depression depended on the number of sessions. For both outcomes, the studies with 20 or more sessions had larger effects than the study that had fewer than 20 sessions, and this difference was statistically significant (Q?=?11.88, df?=?1, p?<?0.001, anxiety; Q?=?9.16, df?=?1, p?=?0.002, depression). No significant effects were found on behavior management or between different music therapy approaches.

Conclusions

Music therapy may be helpful for offenders to improve mental health. Future studies should consider including offenders of both genders, using larger sample sizes, and examining long-term effects. Publication bias may be an issue for this review given the small number of studies and the small sample sizes.

     

Widows and unmarried women as taxpayers in England before 1800

A variety of taxes levied at various dates between the 1540s and the early nineteenth century are analysed to ascertain whether the frequency with which widows and unmarried women are listed as taxpayers matches the ratio between the numbers of widows and unmarried women and the number of men in the adult population. Examination of the tax assessments indicates that the proportion of taxpayers who were women often fell well below their proportion in the general population. This applies in the case of all taxes levied between the sixteenth and early nineteenth centuries and regardless of whether a tax was assessed primarily on goods, houses occupied, or land owned or occupied. That double the proportion of female than of male householders were exempted from payment of the hearth tax on houses they occupied in the second half of the seventeenth century indicates that many women maintained households on very depleted resources. However, the proportion of taxpayers who were women amongst those paying the least tax did not usually exceed the proportion of women amongst those paying most tax.     

Widows and unmarried women as taxpayers in England before 1800

A variety of taxes levied at various dates between the 1540s and the early nineteenth century are analysed to ascertain whether the frequency with which widows and unmarried women are listed as taxpayers matches the ratio between the numbers of widows and unmarried women and the number of men in the adult population. Examination of the tax assessments indicates that the proportion of taxpayers who were women often fell well below their proportion in the general population. This applies in the case of all taxes levied between the sixteenth and early nineteenth centuries and regardless of whether a tax was assessed primarily on goods, houses occupied, or land owned or occupied. That double the proportion of female than of male householders were exempted from payment of the hearth tax on houses they occupied in the second half of the seventeenth century indicates that many women maintained households on very depleted resources. However, the proportion of taxpayers who were women amongst those paying the least tax did not usually exceed the proportion of women amongst those paying most tax.     

Beyond PTSD: mental health consequences of violence against women: a response to Briere and Jordan

This article proposes that we move beyond posttraumatic stress disorder (PTSD) in our conceptualization of traumatic stress responses of victimized women exposed to serial forms of unrelenting violence, such as intimate partner violence and stalking. It is argued that the traditional PTSD framework is ill fitting in the context of some forms of violence against women (VAW), and these limits have consequences for developing appropriate interventions for some victimized women. The article further suggests going beyond PTSD by developing a more nuanced understanding of the ways in which PTSD and other mental health symptoms contribute to the vast array of deleterious personal, societal, and economic costs of VAW.     

Perceived social support and competence in abused children: A longitudinal perspective

The stress-social support-psychological well-being model and the social network theory of child development were used to examine the impact of child abuse and maternal perceptions of social support and competence on child perceptions of social support and competence at two points in time. The influence of child social support on child competence was also assessed. The sample consisted of 165 abused children and their mothers and a matched comparison group of 169 nonabused children and their mothers. As a source of stress, abuse had no significant independent effects on children's perceptions of social support and competence at either time period. The strongest predictors of children's views of their competence were perceived support from mothers, peers, and teachers. The findings underscore the importance of social support for the psychological well-being of children.     

Social-cognitive skills training with a sexually abused and abusive child psychiatric inpatient: Training,generalization, and follow-up

This paper describes the clinical application of a social-cognitive skills training program for an 11 1/2-year-old child psychiatric inpatient with a history of sexual abuse and neglect who was referred for hospitalization after sexually molesting a neighborhood girl. The content and procedures of the program are outlined in detail to facilitate replication. Results indicated that improvements were found on analogue role-play scenarios administered during training-which then generalized to several specific and general measures of social adjustment/competence on the inpatient unit. A 1-year follow-up assessment revealed the maintenance of these therapeutic gains. The implications of this therapeutic approach with maltreated children and need for more rigorous empirical outcome studies are discussed.