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1.
Sexual abuse and exploitation of children and adults with mental retardation and other handicaps 总被引：1，自引：1，他引：1
There is growing recognition that children, adolescents, and adults who are mentally retarded are particularly vulnerable to sexual abuse and exploitation and are in need of intervention services. These people are especially vulnerable due to ther often life-long dependence on caregivers, relatively powerless position in society, emotional and social insecurities, and lack of education regarding sexuality and sexual abuse. In addition the mental health functioning and emotional development of individuals who are mentally retarded are not well understood, and many professionals remain uneducated about their mental health needs. To work effectively with this population, mental health professionals and educators must be alert to what is known about the sexual abuse and exploitation of persons with mental retardation. Furthermore, they need to become educated about the rights of these persons to special legal protection from abuse and neglect and to appropriate and effective mental health interventions. The challenge for mental health professionals and educators is to protect persons who are mentally retarded from sexual abuse and exploitation, to provide appropriate psychotherapeutic interventions when abuse occurs, to respect their right to developmentally appropriate knowledge about sexuality and sexual abuse, and to allow for the fulfillment of their sexuality. 相似文献
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Retrospective case study analysis was done to determine the number of persons retarded due to child abuse and neglect. Analysis was made of 436 cases of mental retardation diagnosed between 1957 and 1973 by a multiprofessional team in Anchorage, Alaska. Independent analysis was made by the two authors using predetermined criteria of maltreatment and reliability of data. Sixty-five of 436 (14.9) cases had evidence of abuse and neglect prior to identification of their retardation. Higher rates of abuse and neglect were found among native Alaskans (Aleuts, Eskimos, and Indians) than Caucasians. Higher rates of abuse and neglect were found among females than males of the mentally retarded population.Paucity of reported studies of abuse and neglect as causes of mental retardation is discussed. It is concluded that abuse and neglect are preventable, but underappreciated, causes of mental retardation. 相似文献
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OBJECTIVE: There have recently been many debates in the UK about how to provide good care for children placed away from home. Professionals have realized that the level of child abuse in foster care and children's homes is high. This research examines the characteristics of physical and sexual abuse of children in foster and residential care in a city in England. The number of cases of abuse reported by pediatricians in this group was compared to the number reported by the same pediatricians for the population of Leeds as a whole. METHOD: This is a retrospective study of 158 children, fostered or in residential care who were involved in 191 episodes of alleged physical and/or sexual abuse assessed and reported by pediatricians over a 6 year period from 1990 to 1995 in Leeds, England. Details of the child including the reason for placement in care, their physical and mental health, abuse characteristics, including perpetrator and case management were studied. RESULTS (see Table 1): 158 incidents of abuse in 133 children in foster/residential care are described. In foster care, 42 children were physically abused, 76 were sexually abused, and 15 experienced both forms of abuse. In residential care, 12 children were physically abused, 6 were sexually abused, and 6 experienced both forms of abuse. In foster care 60% of sexual abuse involved girls and 60% of physical abuse involved boys. In residential care almost twice as many boys as girls were reported to be abused. Foster carers perpetrated the abuse for 41%, natural parents on contact for 23%, and children 20% of incidents. A significant proportion of abuse was severe with 1 death, 8 children with burns, 18 with genital, and 34 with anal penetration. Long-standing emotional, behavioral and learning difficulties were common. Most children (80%) had been abused prior to entry into care. Foster children were 7-8 times and children in residential care 6 times more likely to be assessed by a pediatrician for abuse than a child in the general population. CONCLUSIONS: Children in foster or residential care form an at risk group for maltreatment. Their special needs include additional measures to protect them from abuse. 相似文献
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In a survey of 500 admissions to a short-term residential chemical dependency treatment center for adolescents (ages 12 to 18), 150 adolescents (30%) had been identified as victims of physical and/or sexual abuse. While the abused group had a higher incidence of prior social service and mental health intervention, extraordinarily 68% of these abuse cases had not been reported by children, family, or interviewers prior to the adolescents having entered the chemical dependency residential treatment facility. This chemically dependent, previously abused group was differentiated from a comparison group of nonabused, chemically dependent adolescents, and a second comparison group of nonabused, nonchemically dependent adolescents. Results indicated a higher incidence of acting out behavior, runaways, legal involvement and sexual promiscuity within the abused group. 相似文献
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BACKGROUND: Immediate medical assessment has been recommended for children after sexual abuse to identify physical injuries, secure forensic evidence, and provide for the safety of the child. However, it is unclear whether young children seen urgently within 72 hours of reported sexual contact would have higher frequencies of interview or examination findings as compared to those seen non-urgently or whether forensic findings would be affected by child characteristics, type of reported contact, or later events. DESIGN/SETTING: We evaluated 190 consecutive cases of children under 13 years of age urgently referred during a 5-year period in 1998-2003 to a community child advocacy center and compared them to those non-urgently referred with regard to their physical examination findings, any sexually transmitted infections or forensic evidence, gender, pubertal development, type of contact, reported ejaculation, later bathing or changing clothes, time to examination, and gender, age and relationship of alleged perpetrator. RESULTS: Children seen urgently were younger and had less frequent CPS involvement, more disclosures, and more positive physical examinations, and had more contact with older perpetrators than those seen non-urgently. Overall, most children were female and had normal or non-specific physical examinations. Certain case characteristics were predictive of evidence isolation in the 9% who had positive forensic evidence identified. Semen or sperm was identified from body swabs only from non-bathed, female children older than 10 years of age or on clothing or objects. CONCLUSIONS: Female children over 10 years old who report ejaculation or genital contact without bathing have the highest likelihood of positive examinations or forensic evidence. While there are other potential benefits of early examination, physicians seeking to identify forensic evidence should consider the needs of the child and other factors when determining the timing of medical assessment after sexual abuse. 相似文献
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Sexual abuse leads to short-term and long-lasting pervasive outcomes, including addictions. Among Indigenous Peoples, sexual abuse experienced in the context of residential schooling may have led to unresolved grief that is contributing to social problems, such as pathological (disordered) gambling. The aim of this study is to investigate the link between child sexual abuse, residential schooling and probable pathological gambling. The participants were 358 Indigenous persons (54.2% women) aged between 18 and 87 years, from two communities and two semi-urban centers in Quebec (Canada). Probable pathological gambling was evaluated using the South Oaks Gambling Screen (SOGS), and sexual abuse and residential schooling were assessed with dichotomous questions (yes/no). The results indicate an 8.7% past-year prevalence rate of pathological gambling problems among participants, which is high compared with the general Canadian population. Moreover, 35.4% were sexually abused, while 28.1% reported having been schooled in a residential setting. The results of a logistic regression also indicate that experiences of child sexual abuse and residential schooling are associated with probable pathological gambling among Indigenous Peoples. These findings underscore the importance of using an ecological approach when treating gambling, to address childhood traumas alongside current addiction problems. 相似文献
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Robert M. Gettings 《Educational gerontology》2013,39(5):419-429
The values, policies, and practices of services to persons with developmental disabilities have changed significantly, toward more individually tailored services delivered in the community. Older and disabled persons are linked appropriately in various federal programs, but significant differences must be acknowledged between them and between developmentally disabled persons and other chronically disabled persons. Federal and state policies are shifting, challenging, and stimulating the operations of both aging and developmental disabilities organizations. 相似文献
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Service Learning as a Mechanism for Change in Attitudes and Perceptions of Human Services Students Toward Substance-Dependent Mothers 总被引：1，自引：1，他引：0
The purpose of the study was to explore the potential effectiveness of service learning as a pedagogical technique for providing substance abuse education to human services/social work students. Using a quasi-experimental design, the authors assigned 38 human services undergraduate students to experimental and comparison groups on the basis of their availability to attend a service-learning project in substance abuse. The service learning consisted of a 30-min educational presentation followed by a visit to a residential substance abuse treatment facility for women. Results indicated that service learning in substance abuse had a positive effect on the general knowledge, perceptions, and attitudes of human services students toward substance-dependent mothers and their children. The findings from this exploratory study support future research in this area. 相似文献
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Child sexual abuse is attracting increasing attention in the United Kingdom. In Leeds this is reflected in the work of two pediatricians who receive multiagency, direct referrals for children of all ages. Over two years 1,368 referrals were received for all kinds of abuse and neglect, including 608 for suspected sexual abuse (Hobbs & Wynne, 1987a), of which 337 (243 girls, 94 boys) were confirmed or probable cases. The abuses included genital touching, masturbation, oral, vaginal and anal penetration. Of these abuses, 30% (which were frequently multiple) involved and penetration by finger or penis; and 42% of 337 children exhibited one or more anal findings, rising to 60% of 115 children in the 0-5 years of age group. The diagnosis of abuse was made from results of multidisciplinary assessment including medical examination. Genital findings were present in 3% of boys and 50% of girls. Anal findings included erythema; swelling (tyre); laxity; shortening or eversion; reflex anal dilatation (dilatation); fissures; venous congestion; reversible and permanent skin changes; twitching; funnelling; hematoma and bruising; as well as signs of infection. The pattern of anal signs varied with the age of the child and chronicity of abuse, as judged from the history. Healing and resolution of anal physical findings on follow-up were observed from days to months after initial examination. The general absence of these findings in the group of children judged not to have been sexually abused supports a cause and effect hypothesis, but further research is required. Medical examination of every child where symptoms, signs, or situation raise the possibility of abuse or neglect must include anal inspection, but instrumental or digital examination is not recommended. 相似文献
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OBJECTIVE: The goal of this study was to compare rates of positive medical findings in a 5-year prospective study of 2384 children, referred for evaluation of possible sexual abuse, with two decades of research. The prospective study summarizes demographic information, clinical history, relationship of perpetrators, nature of abuse, and clinical findings. The study reports on the results by patterns of referral and the medical examination. RESULTS: There were 2384 children evaluated in a tertiary referral center between 1985 and 1990 for possible sexual abuse. Children were referred after they disclosed sexual abuse, because of behavioral changes or exposure to an abusive environment, and because of possible medical conditions. A total of 96.3% of all children referred for evaluation had a normal medical examination; 95.6% of children reporting abuse were normal, 99.8% who were referred for behavioral changes or exposure to abuse were also normal. Of the 182 children referred for evaluation of medical conditions, 92% were found to be normal at the time of examination by the Child Advocacy Center. The remaining 15/182 (8%) that were found to be abnormal were diagnosed with sexually transmitted diseases, acute or healed genital injuries, and were 17% (15/88) of the total cases found to have medical findings diagnostic of abuse. Interviews of the children indicated that 68% of the girls and 70% of the boys reported severe abuse, defined as penetration of vagina or anus. Penetration was associated with a higher percentage of abnormal findings in girls (6%) compared to 1% of the boys. The relationship of the abuser impacted on the severity of the abuse. CONCLUSION: Research indicates that medical, social, and legal professionals have relied too heavily on the medical examination in diagnosing child sexual abuse. History from the child remains the single most important diagnostic feature in coming to the conclusion that a child has been sexually abused. Only 4% of all children referred for medical evaluation of sexual abuse have abnormal examinations at the time of evaluation. Even with a history of severe abuse such as vaginal or anal penetration, the rate of abnormal medical findings is only 5.5%. Biological parents are less likely to engage in severe abuse than parental substitutes, extended family members, or strangers. 相似文献
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OBJECTIVE: This study compares abnormal genital examination findings made by pediatric emergency medicine (PEM) physicians to examinations by physicians with training in child sexual abuse in the evaluation of prepubertal girls for suspected sexual abuse. METHOD: A prospective study was performed following the genital examination by a PEM physician of prepubertal girls suspected of being sexually abused. A physician with training in child sexual abuse re-examined those girls whose examinations were interpreted as abnormal by the PEM physicians. The findings and interpretations of the PEM physician were then compared to those by the physicians with training in child abuse. RESULTS: Between October 1994 and October 1998, 46 patients diagnosed by PEM physicians with nonacute genital findings indicative of sexual abuse were re-examined by a physician with training in child abuse. The follow-up examinations were done 2 days-16 weeks (mean 2.1 weeks) after the emergency department visit. The physicians with training in child abuse concluded that only eight of these children (17%) showed clear evidence of abuse. Normal findings were noted in 32 children (70%), nonspecific changes were noted in 4 children (9%), and 2 children (4%) had findings that are more commonly seen in abused children than nonabused children but are not diagnostic for abuse (concerning for abuse). CONCLUSIONS: There was poor agreement between the pediatric emergency medicine physicians and the physicians with training in child sexual abuse. This study suggests that emergency medicine physicians should consider additional training in this area. In addition, all children with abnormal ED examinations should have follow-up examinations by a child abuse trained physician. 相似文献
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Although adolescents are severely and chronically physically abused, relatively little attention has been directed towards understanding this phenomenon. This study explored the family characteristics and the behavioral-emotional reactions of 77 adolescents who were physically maltreated. The youths were selected at a number of sites including a runaway shelter, a hospital-based child abuse team, and a protective service unit. Six different patterns of adolescent reaction to abuse were identified: acting-out, depression, generalized anxiety, extreme adolescent adjustment, emotional-thought disturbance, and helplessness-dependency. Abuse toward these youth had been ongoing for an average of nearly five years. As there were no differences in family characteristics and emotional-behavioral reactions between subjects who were abused only during adolescence (including single-incident abuse) and subjects for whom family violence was evident from childhood on, the utility of a developmentally specific system of abuse categorization is questioned. It is suggested that it is the pattern of parent and child interaction rather than the course of the maltreatment that is related to the emotional and behavioral dysfunction of the adolescent victim. 相似文献
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Selected characteristics of 290 reports of physical abuse, sexual abuse and neglect in foster homes, group homes, residential treatment centers, and institutions are described. At each type of setting physical abuse reports were most common, and neglect reports were least common. Quantitative and qualitative methods demonstrate that a significant percentage of confirmed reports are of a serious nature. Injuries occurred most frequently because of physical abuse while sexual abuse reports were most likely to be confirmed. Prior allegations of abuse or neglect regarding the perpetrator were indicated in 27% of reports. Factors contributing to abuse and neglect and the role of a state institutional review team in developing a systematic approach to this problem are discussed. 相似文献
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OBJECTIVE: To determine how often and for what reasons a hospital-based multidisciplinary child abuse team concluded that a report of alleged or suspected child abuse was unnecessary in young children with fractures. METHODS: A retrospective review was completed of all children less than 12 months of age who, because of fractures, were referred to the hospital multidisciplinary child abuse team for consultation regarding the need to consider child abuse. RESULTS: The team received 99 consultations, reported 92 (93%) children as alleged or possible victims of physical abuse, and did not report 7 (7%). Age at presentation of those who were reported was 4.2 months compared to 3.0 months in the non-reported group. The average number of fractures in the reported group was 2.9 (SD 3.53) compared to 3.4 (SD 4.6) in the non-reported group. Factors that led to cases not being reported included: (a) a trauma history consistent with the fracture (n=4), (b) a diagnosis of bone fragility secondary to genetic, nutritional or medical therapy etiologies (n=2), and (c) iatrogenic fracture (n=1). CONCLUSIONS: Seven percent of the children less than 12 months of age and with at least one fracture referred to the multidisciplinary team for evaluation of possible child abuse were not reported as alleged or suspected physical abuse. The involvement of the hospital multidisciplinary child abuse team may have prevented unnecessary investigation by the county social services agency and/or police, and possible out-of-home temporary placement. 相似文献
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The authors present a chart review of 125 children, 6 years of age and under, who presented between early 1981 and mid 1983 to an acute care hospital because of sexual abuse. They represented one-third of the cases of alleged sexual abuse between infancy and 18 years of age referred to the hospital's multidisciplinary sexual abuse team. The ratio of females to males was 3.3:1. Sixty percent of the children were victims of intrafamilial abuse. Of the preschoolers, 72.5% were victims of intrafamilial abuse. At school age there was a reversal with 73% of 6 year olds being abused by extrafamilial offenders. The duration of the abusive relationship was greater in intrafamilial abuse. Purposeful disclosures were more frequent overall but were significantly less frequent when the perpetrator was intrafamilial or when the child was a preschooler. Two-thirds of the children had physical and/or behavioral symptoms. Parents of children who had been the victims of intrafamilial abuse were more likely to be separated or divorced. The difficulties in assessing young victims of alleged sexual abuse and the implications of the findings in this review are discussed. 相似文献
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This article reports findings obtained in a study that sought to identify factors that influence the willingness of persons associated with and involved in 24-hour residential care to report possible abuse and neglect events. A total of 598 respondents from 33 counties in 5 states were presented with a potentially reportable abuse or neglect situation and were asked to indicate their willingness to report that situation. Characteristics of the event, the resident, staff, and measures of the attitudes of respondents were included in an hierarchical regression model to determine their respective impacts on willingness to report. A model that explained about 45% of the variance in willingness to report was obtained. 相似文献
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Fifty-four abused and neglected children have been referred to our multidisciplinary team for assessment and treatment. There were many more boys than girls (36 vs 18) and the mean age was 3.3 years. Half of the children were admitted for medical reasons and abuse or neglect were secondary findings. The medical findings included bruises and fractures, head injuries, knife wounds, and failure to thrive. The children's main characteristics were: “difficult children,” unwanted pregnancies, difficult pregnancies and deliveries and half of them were separated from their mothers during the first months of life due to illness. The families were characteristic of multiproblem families of low social level. Almost all parents were young when married and half were unemployed or had unsteady employment. In most cases the parents were socially isolated and had poor relations with their families of origin. Most mothers and half of the fathers had an unhappy childhood while almost half of the mothers had a psychiatric problem. In general, our findings were in accordance with those described in other nations. Nevertheless, there were some characteristics which seem to be of relevance within the Greek ethnic and cultural context. The legal problems as well as those pertaining to child protection are discussed. 相似文献
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Jackson SL 《Child abuse & neglect》2004,28(4):411-421
OBJECTIVE: Child Advocacy Centers (CACs) are designed to improve the community collaborative response to child sexual abuse and the criminal justice processing of child sexual abuse cases. CACs, in existence for 16 years, now have standards for membership developed by the National Children's Alliance (NCA) that include nine core components. And yet no systematic examination of the CAC model exists. The purpose of this paper was to assess the variations within these core components as they exist in the field. METHOD: Using a stratified random sampling design, 117 CAC directors were interviewed using a semi-structured interview that was based on the NCA's standards for membership. The eight core components of the CAC model examined in this study include: a child-friendly facility, a multidisciplinary team, an investigative child interview, a medical examination of the child, provision of mental health services, victim advocacy, case review, and case tracking. RESULTS: Results reveal the CAC model has been widely adopted by both member and nonmember centers, although variations in implementation exist. CONCLUSIONS: Future developments in the CAC model must include evaluation of the model. 相似文献