'A kindergarten teacher must have 100 eyes and 100 ears!': Kindergarten teachers' experiences coping with child sexual abuse and problematic sexual behavior

BACKGROUND

Child sexual abuse (CSA) and problematic sexual behavior (PSB) are worldwide phenomena that occur across all ages. Kindergarten teachers' proactive involvement can be crucial to the prevention, disclosure and intervention of CSA and PSB. However, research on their experiences of contending with CSA and PSB remains limited.

OBJECTIVE

This study examines kindergarten teachers' experiences in Israel with the CSA and PSB of their students.

PARTICIPANTS AND SETTING

Semi-structured interviews were conducted with 31 teachers: 11 secular Jewish, seven religious Jewish, nine Druze Arab, and four Muslim Arab.

METHODS

A qualitative analysis was conducted using the interview transcripts as data.

RESULTS

The analysis revealed three themes illustrating teachers' professional transformations regarding their knowledge of these phenomena: 1) initial shock, uncertainty and sense of responsibility when exposed to CSA and PSB due to missing knowledge, 2) implementation of prevention and intervention strategies regarding CSA and PSB, and 3) embracing a social role to disseminate CSA and PSB knowledge. The findings indicated that the majority of the teachers went from overwhelming shock and fear due to a lack of knowledge in coping with CSA and PSB to a sense of responsibility as a community leader.

CONCLUSIONS

The fragmentation of the Israeli education system isolates kindergartens, and the lack of training and education for the teachers left them alone when contending with the CSA and PSB of their students. Nevertheless, the participants exhibited remarkable agency and resourcefulness, gaining the necessary knowledge and acting as knowledge agents within their communities.

"We Try to Fix Things Quietly, and We Do Not Take Revenge": Christian Arab Teachers' Experiences Coping with Child Sexual Abuse Among Their Pupils in Israel

Teachers are at the frontlines of the fight to identify and cope with child sexual abuse (CSA) among their pupils. Their methods of coping with CSA cases, both personally and professionally, are strongly influenced by their socio-cultural contexts and religious beliefs. The purpose of the present study was to investigate the experiences of Christian Arab teachers in Israel coping with the CSA of their pupils. Twelve Christian Arab elementary school teachers in Israel were recruited for the study. Semi-structured interviews were conducted, and a qualitative thematic analysis was employed based on a descriptive phenomenological-psychological approach. Two key themes emerged from the analysis: (a) The teachers' intense emotional reactions regarding the CSA of their students and the empowerment some found in handling such difficult situations, and (b) The teachers' Christian beliefs and identity strongly affected their understanding of CSA and their approach to intervention. The findings indicated the dialectical position of the teachers' religio-cultural context, particularly the duality of the Christian value of forgiveness, a powerful resource for their coping, yet with adverse implications for children's vulnerability. This unique risk should inform training teachers regarding CSA matters. Teachers must also have systems that support them and allow them to reflectively examine their coping styles.

"We Need to Raise Awareness and Never Give Up": Israeli Druze and Muslim Arab Kindergarten Teachers' Proactivity When Facing the Sexual Abuse of Their Students

Kindergarten teachers are expected to lead the intervention process in cases of child sexual abuse (CSA) in their kindergarten. This study examines the proactive role of Druze and Muslim Arab kindergarten teachers in addressing and coping with the CSA of their kindergarten students in Israel. A qualitative thematic analysis was used to investigate the semi-structured interviews conducted with eight Druze Arab and six Muslim Arab kindergarten teachers. Three distinct themes were revealed. The first theme described the participants' fear and concern for their personal children and themselves when dealing with CSA incidents involving their students. The second and third themes described their proactive coping on two fronts: (1) inside their homes to protect their own children and (2) as educators within religious communities, using professional and religious principles to support CSA survivors and raise awareness among parents. The results emphasized the personal burden on kindergarten teachers coping with CSA in their kindergarten and, as mainly expressed by Druze kindergarten teachers, the contribution of religious values to CSA intervention and prevention processes among their students and communities. Thus, there is a need for comprehensive support that considers ethnic and religious characteristics and will be available to kindergarten teachers facing CSA in their kindergarten.

"I have a special prayer 'O Lord, open my lips'": Experiences of ultra-Orthodox educators after their students' disclosures of sexual abuse

BACKGROUND

Child sexual abuse (CSA) is a large-scale, worldwide phenomenon. However, research on educators' experiences with CSA in specific social, cultural or religious contexts is limited.

OBJECTIVE

The current study is part of a larger qualitative research project examining Israeli educators' coping with CSA of their students in diverse cultural contexts. This study focused on Jewish ultra-Orthodox educators' perceptions and experiences of CSA disclosure and its impact on their professional and personal lives. Their perceptions of belonging to the ultra-Orthodox community were also explored.

METHODS

Interviews were conducted with 28 ultra-Orthodox educators and analyzed using a thematic approach.

RESULTS

The ultra-Orthodox educators perceived their roles on a continuum, from not being responsible to being fully responsible. They perceived the abused children as having negative behavior or as victims who deserved protection. Their personal lives were deeply affected, impacted by fear, disassociation or devotion to the mission of caring for these children. Finally, educators perceived the ultra-Orthodox community as fragile regarding CSA disclosure and emphasized the importance of encouraging culturally adaptive ways to conceptualize and address CSA.

CONCLUSIONS

This study highlights the importance of ultra-Orthodox educators in identifying CSA and leading interventions. It also raises the need for training to combine reflective, cultural-based practice and support for the educator to maintain their wellbeing. Despite this community's uniqueness, the current findings may be relevant to professionals and policymakers regarding other closed and religious communities and diverse educational settings confronting CSA.

"One Day It Will Be Over, and You Will See Other Landscapes. . . You Are Not Alone": Adult Survivors' Messages to Children Undergoing Child Sexual Abuse

Child sexual abuse (CSA) has received considerable attention from scholars, contributing to policy, intervention, and prevention efforts worldwide. However, survivors' involvement in this research is limited. This study was designed to delve into the messages of adult CSA survivors to abused children. In all, 371 written testimonies were provided to the Israeli Independent Public Inquiry on CSA by survivors from diverse communities in Israel. The Inquiry aimed to promote change in policies related to CSA. The testimonies were analyzed using the qualitative thematic analysis method. The results revealed five main messages emphasized by survivors to children experiencing CSA: (a) transferring the responsibility and guilt from children to perpetrators and society; (b) turning toward the light and continuing on; (c) disclosure is essential; (d) a happy life is possible; and (e) together we can survive. The discussion emphasizes how various systems in survivors' lives have profound impacts following the abuse. Although survivors were from diverse backgrounds, their messages to abused children were consistent. Through their messages to the children, the survivors emphasized their wish to transfer responsibility and guilt from children experiencing abuse to the society that is supposed to see, listen, protect, and validate. Implications for practice are discussed, focusing on the importance of making room for survivors' voices and experiences in the processes of shaping policies in the area of CSA. Moreover, the survivors' desire to be there for the children emphasized the urgent need to promote the perception of survivors as key stakeholders in the field of child abuse and to integrate their experiences and perceptions into the formal and informal systems for children.

"We were there all alone": Sexual abuse within the peer group in boarding schools in Israel - Retrospective perceptions of adult survivors

BACKGROUND

Despite the extensive research on child sexual abuse and the alarming extent of the phenomenon among peers, certain perspectives are still missing.

OBJECTIVE

The current study aimed to explore the subjective experience of adult survivors of peer sexual abuse while in boarding school, which has rarely been explored.

PARTICIPANTS AND SETTING

The present study included 15 adults who were sexually abused by their peers while attending boarding school.

METHODS

The data were based on semi-structured in-depth interviews focused on the abuse story, disclosure, and the meaning of the boarding school context to the participants. The interviews were analyzed using the qualitative thematic analysis approach.

RESULTS

The findings characterized the boarding school as lacking parental figures, lacking rule and regulation enforcement, and staff who were not able to deal effectively with sexual abuse cases. The relationships within the peer group in the boarding school were characterized by intense, although unspoken, intimacy and sexuality. As part of the group's socialization, breaking the rules was encouraged, including in the sexual realm. Furthermore, the boarding school was perceived as a space that maintained conservative patriarchal social structures that encouraged traditional gender perceptions.

CONCLUSIONS

The findings of the current study indicated the urgent need to advance both policy and practice in this area, for example, greater involvement of the boarding school staff in the lives of the adolescents and implementation of rules and regulations to create a safer climate for those who choose, or need, to live away from home.

What Can We Learn About the Others Present During Incidents of Child Abuse?: Key Lessons and Future Directions Based on a Scoping Review

Child abuse (CA) is a global problem that has received attention from policymakers, researchers, and practitioners. The majority of studies have focused on the phenomenon's epidemiology and consequences, alongside groundbreaking writing on victims and perpetrators. The concept of others who are present during the abuse is understudied and underdeveloped, despite its vital importance in better understanding children's experiences as well as their disclosure. The current study was designed to spotlight the phenomenon of others' presence, beyond the victims and perpetrators, during child abuse incidents. The current literature review was guided by a scoping review strategy. The results revealed scant empirical data, with only 15 studies meeting the inclusion criteria of the study. The articles that met the inclusion criteria addressed other people's presence during CA incidents, were published in peer-reviewed journals, and were written in the English language. These articles' analyses addressed the relations of the survivors with these others, pointing mainly to two identities: accidental bystanders who are not familiar with the child and family members of the child. The results provided a glance into the process that accidental bystanders go through during the abuse and the meaning of their presence for those who are family members. The perceptions and experiences of the children themselves with respect to the presence of the others during the abuse are noticeably lacking. The key conclusion from the current scoping review pinpoints the urgent need to advance the empirical knowledge on the presence of others during incidents of child abuse, especially others who are familiar to the children and are a significant part of their lives. The conceptualization of this phenomenon has the potential to better adapt prevention and intervention efforts in the field of child abuse.

Not a happy story. A love story: Professional perceptions of love in families with child sexual abuse in two US mid-Atlantic Child Advocacy Centers

BACKGROUND

Although research on child sexual abuse (CSA) has greatly evolved, studies revealing survivors' conflicting feelings towards their perpetrators and family members are scarce. Professionals' perceptions of love in intrafamilial CSA are often overlooked.

OBJECTIVE

The current study examined the perceptions of professionals working on CSA multidisciplinary teams (MDT). The research questions were: (1) How do professionals define love in families with CSA? (2) What are professionals' perceptions of parental love in families with CSA? (3) What are professionals' perceptions of love from the abused child towards their parents and siblings? (4) What are the differences between professionals' perceptions of love and those of the families they serve, and how do professionals deal with these different perceptions during interventions?

METHOD

Five focus groups with a total of 34 child advocacy center (CAC) and MDT professionals from two CACs in the US mid-Atlantic region were conducted virtually and analyzed using a thematic approach.

RESULTS

The findings indicated that professionals recognized parental love at the center of familial child sexual abuse (FCSA) cases and its range from benevolent and healthy to maladaptive, offensive love. Professionals also recognized the mechanisms enabling children's love for both offending and non-offending parents and complex expressions of love between siblings, even when one sibling sexually abused another.

CONCLUSIONS

This study highlights the importance of promoting discourse on love in cases of intrafamilial CSA. Recognizing and embracing the complexity of love bonds may empower the abused child and support their need to believe in their parents' love.

Child Sexual Abuse by Religious Authority Figures in Germany and Israel: The Experiences and Perceptions of Adult Survivors

The current study is based on an in-depth thematic analysis of 20 interviews with German and Israeli adult survivors of child sexual abuse (CSA) by religious authority figures (RAF). This paper aims to explore survivors' experiences within the Jewish ultra-Orthodox and Christian communities, as well as to draw comparisons between the abusive structures and disclosure in these two contexts. The results point to the complexity of CSA by RAF, which is embedded in the survivors' perceptions of themselves as emotionally and cognitively captured by the perpetrators who are a symbol of a parent or God and faith. The participants expressed great concern regarding disclosing the abuse against the backdrop of familial, cultural, and community inhibitors, such as fear of social stigmatization, inability to recognize the abuse, and the taboo of sexuality discourse. The survivors' traumatic experiences were intensified in light of negative social responses to disclosure and encounters with insensitive officials. A comparison of the cultures revealed differences regarding the nature of community life and educational institutions, which may have shaped the disclosure and recognition of the abuse. The study highlights the importance of comparative follow-up studies related to this phenomenon in order to examine its universal and unique cultural contexts.

"The most shocking thing was that I didn't respond to the abuse": The peritraumatic responses and transitions as conveyed by survivors of continuous child sexual abuse

BACKGROUND

Child sexual abuse (CSA) is a worldwide phenomenon with ongoing and far-reaching consequences for millions of children worldwide. It is a consensus among researchers that continuous CSA represents a unique challenge.

OBJECTIVE

The current study aimed to explore the peritraumatic responses of survivors of continuous CSA as described in their written narratives of abuse. The transitions between the peritraumatic responses will also be examined, highlighting the unique context of continuous CSA.

PARTICIPANTS AND SETTING

Written narratives of CSA were recruited via an advertisement in the media inviting CSA survivors to share their stories of abuse on an anonymous online platform. The data collection was carried out under the Israeli Independent Public Inquiry on CSA.

METHODS

A qualitative thematic analysis was applied to 32 richly written accounts of abuse.

RESULTS

Three peritraumatic responses were identified: the adaptive response, hinting, and attempts to fight and flight. Transitions between these responses were described by the survivors and addressed the heavy load of the abuse, realization of the abuse, fear of consequences and the central role of the survivor's environment.

CONCLUSIONS

The current study provides a unique platform for the exploration of peritraumatic responses in continuous CSA. Alongside the identification of three peritraumatic responses described by the survivors, the current study provides an initial glance into transitions between peritraumatic responses. This insight strengthens the developing notion that peritraumatic responses in the unique context of CSA are a top-down process, often shaped by various contexts and multidimensional dynamics in the children's lives.

"A Little Bit of Light Dispels a Lot of Darkness": Online Disclosure of Child Sexual Abuse by Authority Figures in the Ultraorthodox Jewish Community in Israel

Social media sites such as Facebook have become popular platforms for promoting public awareness of sexual abuse by encouraging user engagement around this issue. There is, therefore, currently emerging research on the functions and implications of social media as a platform for sexual abuse disclosure. However, as yet, no study has examined this phenomenon specifically through a religious-cultural lens. This study explores perceptions of, barriers to, and motives underlying online disclosure of child sexual abuse (CSA) by religious authority figures (RAFs) in ultraorthodox Jewish society in Israel. The data were gleaned from the popular Facebook page of a nonprofit devoted to raising awareness of CSA in the ultraorthodox community. The analysis was based on admins' posts, anonymous and nonanonymous survivors' shares, users' comments, and in-depth interviews of eight page users. The findings suggest a culture-oriented model of online CSA disclosure (OCSAD), identifying four primary factors (safety, benefit, relevance, and legitimacy) that, weighed against cultural barriers, influence the decision to engage in online CSA disclosure. This context-informed understanding highlights the importance of social media as an alternative platform for CSA disclosure in an isolated but changing cultural arena such as the ultraorthodox community in Israel. The theoretical model is of international interest for its conceptualization of the unique characteristics and perceptions of OCSAD within religious-cultural contexts.

School principals coping with child sexual abuse in their schools

BACKGROUND

Schools serve a central role in prevention, disclosure and intervention in cases of child sexual abuse (CSA). As school principals often face CSA cases in their daily work, they may hold the key to making social change on this front. However, research on principals' experiences of contending with CSA remains limited.

OBJECTIVE

The current study is part of a larger qualitative research project examining various Israeli educators' coping with CSA among their students in diverse cultural contexts. In this study, we specifically focused on principals. The research questions were: (1) What are the unique ways in which school principals cope with cases of CSA during their course of daily work? (2) Do their cultural contexts and cultural affiliations shape their coping, and if so, how?

METHODS

In-depth interviews were conducted with 25 principals from multiple cultural groups (secular, religious and ultra-Orthodox Jews, and Arab-Muslims), which were analyzed using a thematic approach.

RESULTS

The findings indicated that principals demonstrate three types of coping strategies in response to encounters with CSA in the course of their work: they may act as "navigators" (exclusively responsible); "sharers" (rely on teamwork); or "balancers" (negotiating between cultural and legal demands). Furthermore, two contextual factors affected their construction of coping: ongoing professional experience in cases of CSA and personal experiences, including being a CSA survivor.

CONCLUSIONS

This study highlights the importance of principals in identifying and leading interventions for CSA cases. It also raises the need for training to combine reflective, experience-based practice alongside evidence-informed practice.

Trapped in a Maze: Arab Teachers in Israel Facing Child Sexual Abuse Among Their Pupils

Cultural contexts are formative of and fundamental to how individuals understand, conceptualize, and act within a context of violence. Conceptually and methodologically, however, research from a culturally informed perspective on the experiences of teachers contending with the violence of child sexual abuse (CSA) in particular is broadly limited. As educators frequently confront cases of CSA in their everyday work, their ability to promote detection, disclosure intervention, and especially prevention gives them the potential to be agents of social change; however, while their responsibilities are critical, they are simultaneously members of their communities and cultures, and their interactions are bound by these dynamics. The purpose of the study is to analyze the experiences of Arab teachers in Israel who confront CSA in their everyday work. The findings are based on qualitative thematic analysis of semi-structured interviews conducted with 30 female Arab teachers working within the Arab school system in Israel. Results indicate that when facing CSA, the teachers experience an ongoing conflict between their cultural and professional codes, trapping them in a maze of intertwining and oppositional demands. On the one hand, they are constrained by the norm of protecting the honor and maintaining the status and reputation of those involved, including themselves; on the other hand, as empathetic professionals, they desire to aid their pupils. While the participants do not accept the status quo, they are effectively at a loss as to how to change it. In order find a way out of their entrapment in coping with CSA among their pupils, the only currently available path is to act as a lone hero; there is, however, the potential to foster the development of a secondary culture within the school to inaugurate cultural change in coping with CSA. Implications for future research, policy, and practice are discussed.

"If you don't send me five other pictures I am going to post the photo online": A qualitative analysis of experiences of survivors of sextortion

In this study, we explored survivors' experience with sextortion (threats to expose sexual images to coerce victims to provide additional pictures, sex, or other favors). We conducted in-depth telephone interviews with 48 adults aged 18 to 25 who had been targets of sextortion. Nearly half of participants were minors at the time of the sextortion incident. Data were analyzed using thematic analysis, which resulted in four major dimensions. The dimensions identified were the emotional connections between victims and perpetrators, the nature of the threats, societal responses, and integrating the sextortion into their life stories. The findings emphasized the multidimensional nature of this phenomenon. There was a wide range of emotional connections, from brief connections to close intimate relationships or strong friendships. Some threats remained unfulfilled, while other were carried out. Some threats were one-time and some lasted for years. Societal responses were central in participants' narratives, with most participants actually turning to their peers and parents for support. Many expressed thankfulness for the opportunity to tell their story during the interviews. For the majority of participants sextortion was perceived as a central event in their lives, one that changed them forever. Listening to the voices of survivors helps professionals understand these harmful situations.

"Yes, My Uncle, I'll Do Whatever You Say": Experiences of Israeli Muslim Arab Children During Forensic Interviews Following Child Sexual Abuse

Children from Arab society in Israel have been overlooked in previous studies and efforts in the area of forensic interviews. The current study provides an in-depth thematic analysis of 30 forensic interviews with Israeli Muslim Arab children following child sexual abuse (CSA), all conducted by Arab forensic interviewers. In multicultural Israeli society, Muslim Arabs make up 18% of the population. In addition to the religious and cultural difference, this minority is involved in an ongoing conflict with the majority Jewish society in Israel and tends to have low trust of government authorities. This background necessarily affects the area of forensic interviews with children. The research explores the unique encounter between maltreated children from Israeli Muslim Arab society and forensic interviewers, highlighting its particular characteristics and challenges. Data analysis revealed a central theme of a clash of worlds. The forensic interviewers, although hailing from a similar background as the children, followed best practices developed in western societies. The children, on the other hand, faced enormous conflict in addressing CSA terminology and complying with the requirements of the forensic world in ways that are forbidden to the them in their own. Moreover, having been educated to accept the authority of adults unquestioningly, the children were torn between the difficulty of disclosing the abuse to someone outside the family, and the obligation to communicate candidly with the adult interviewer as required in the forensic context. The findings highlight the urgent need to reform the services these children receive and to dedicate future efforts to further assessment of cultural context and its impact on maltreated children, particularly in the forensic context.

Public Attitudes Toward Institutional Child Sexual Abuse in Israel: The Case of Malka Leifer

This study examined Israeli public perceptions of institutional child sexual abuse (CSA) in the Malka Leifer case. Leifer is a Jewish ultra-Orthodox former Melbourne school principal who is wanted in Australia on CSA charges, after fleeing to Israel. Based on a qualitative analysis of 2,451 reader comments retrieved from four Israeli news websites and six public Facebook pages, the findings indicated diverse attitudes toward the alleged perpetrator, the ultra-Orthodox Jewish community, state authorities, and victims. All parties involved were criticized, but less so the victims. Criticisms included sociopolitical and gender stereotypes, and demonic attributions. Positive comments were directed at all involved, even the alleged perpetrator, and especially the victims. The results demonstrate the need to better understand CSA portrayals in cyberspace, as they affect both public and policymaker attitudes, and the importance of fighting prejudicial discourse about the ultra-Orthodox community, especially in light of its changing attitudes regarding CSA.

Lover, Mentor, or Exploiter: Retrospective Perspectives of the Older Person Following Sexual Relationships with Adults During Adolescence

Sexual relationships between an adolescent and an older person are considered controversial and in many countries are conceptualized under the legal definition of statutory relationship/rape. Despite the consensus regarding their potential negative implications, little is known about how adolescents perceive and construct them. To address this lacuna, the current exploratory study examined how individuals who have experienced sexual relationships with an adult while growing up perceived the older person and the meaning they ascribed to the age gap (M age gap, 7.78 years; range, 2-18 years). A qualitative thematic methodology was incorporated in analyzing in-depth semi-structured interviews with 28 individuals (M age, 29.89 years) who had experienced sexual relationships with an (at least 2 years) older person during adolescence (M age, 14.78 years). Participants described five different perceptions of the older persons: romantic partner; sexual partner; authority figure; complex/unstable figure; and exploiter. Subsequent analysis, focusing on the role participants assigned to age when describing these different images of older persons, shed additional light on their subjective perceptions; namely, for each image, age had a particular meaning. This paper may contribute to the understanding of individuals' experiences of sexual relationships with an older person by emphasizing the complexity of such relationships, as reflected in the participants' construction of the older person's image, potentially providing important information that can inform best practice for professionals working with this population. Findings highlight the need to address diversity and ambiguity rather than the uniform dichotomy that characterizes the legal framing of automatically constructing these relationships as statutory. Further implications for research, policy, and practice are discussed.

Disclosing the abuse: The effect of ethnoreligious identity on CSA disclosure in forensic interviews

Multiple studies have examined sexually abused children and their interactions with the legal system, as manifested in children's disclosures of sexual abuse during forensic interviews. Nevertheless, few have done so while referencing contextual variables, such as ethnoreligious identity. The current study was designed to examine how ethnoreligious identity affects children's disclosure in forensic interviews beyond the contribution of child characteristics and abuse characteristics. In addition, the moderating role of pre-interview disclosure was examined. An analysis of 1054 forensic interviews conducted in Israel indicated a relationship between a child's age, gender, and abuse characteristics (i.e., perpetrator identity and type of abuse) with the likelihood of disclosure during the forensic interview. The results indicated a relationship between ethnoreligious identity and forensic disclosure. Unexpectedly, Muslim Arab children were more likely to disclose than Jewish children. Predictably, pre-interview disclosure moderated the relationship between abuse characteristics and ethnoreligious identity (among Jews) and forensic disclosure. Conversely, it did not moderate the relationship between child characteristics and disclosure during the forensic interview. The findings demonstrate the importance of a context-informed examination of child abuse disclosure and its potential to advance the development of services adapted to children from diverse communities.

"Maybe I imagined it, maybe it really was all just childish play": Complexity and ambiguity in survivors' perceptions of harmful preadolescent sexual behavior

BACKGROUND

Harmful preadolescent sexual behavior (HPSB) is an understudied phenomenon in the field of child sexual abuse (CSA).

OBJECTIVE

The purpose of the present study was to analyze and describe the experiences and perceptions of adult survivors of HPSB.

PARTICIPANTS AND SETTING

16 survivors of HPSB were recruited as part of a purposeful sample. Their ages at the time of the study ranged from 21 to 50; they were Jewish-Israeli, secular, and Hebrew-speaking.

METHODS

Semi-structured interviews and qualitative thematic analysis were conducted based on a descriptive phenomenological-psychological approach.

RESULTS

Participants described elements of complexity in their perceptions of the "truthiness" of their memories and the mutuality of the HPSB experiences, as well as their primacy, seriousness, and life impact. They also described elements of support during disclosure, but mostly exposed the challenges and hardship involved, particularly the lack of legitimacy in exposing harmful sexual behavior perpetrated by other children.

CONCLUSIONS

Both the HPSB experiences themselves and the subsequent disclosure contributed to the development of detached, mistrustful identities among the participants.

"And I Let It All Out": Survivors' Sibling Sexual Abuse Disclosures

There is consensus in child sexual abuse (CSA) literature with respect to the central role of the disclosure process. However, CSA disclosure is challenging for all children, those who have experienced intrafamilial abuse. In recent years, there has been growing research into sibling sexual abuse (SSA), which is a prevalent and severe, but also the least studied form of intrafamilial CSA. This study was designed to advance theory on SSA disclosure by examining the narratives of adults who have disclosed the abuse and discuss it with reference to the perceived role of disclosure recipients-including perpetrating siblings, parents, and professionals. In-depth interviews with 25 adults were conducted and analyzed thematically. The results highlighted the significance of disclosure for survivors, as well as the central roles played by significant others in the process, including the offending and nonoffending siblings, parents, and professionals. The discussion addresses the important role of the family system in the disclosure narratives. The conclusions point to the need of all actors taking part in the disclosure itself, as well as in the survivors' lives postdisclosure, to become "better" disclosure recipients by acknowledging survivors' needs. This in turn would also empower survivors to disclose their stories and cope with the potential familial and societal ramifications of their disclosure.

Comparison of children's advocacy center responses to harmful sexual behavior among siblings: An international perspective

BACKGROUND

Harmful sexual behavior (HSB) is sexual behavior exhibited by children and adolescents that is developmentally inappropriate and/or harmful or abusive towards themselves or others. Victims of children with HSB are commonly siblings. Multiple professionals may be involved in cases of youth HSB involving siblings, which places Children's Advocacy Centers (CACs) in a key position to directly address intrafamilial HSB. Approximately 25% of all cases seen at CACs in the U.S. are youth-initiated HSB. However, no known research has examined how CAC professionals approach decision-making and response to intrafamilial and sibling HSB, particularly across regions and cultures.

OBJECTIVES

To examine the perspectives of professionals from three separate CACs in Israel, eastern U.S., and southwestern U.S. regarding their decision-making and response process for sibling HSB.

PARTICIPANTS AND SETTING

Thirty-seven multidisciplinary team members from the three CACs, including representatives from child welfare, law enforcement, family advocacy, mental health, and the court system, among others, participated in the study.

METHODS

Participants completed focus groups that asked them to discuss how their system would respond to a vignette case. Dedoose was used for thematic analysis.

RESULTS

Using qualitative thematic analysis, results indicate all sites perceived sibling HSB as a family crisis, and they prioritized establishing safety and providing therapeutic interventions. Differences across sites were on how to establish safety and when to use legal actions.

CONCLUSIONS

The study draws attention to the influences that formal policy and community contexts have on CAC decision-making, particularly around the availability of evidence-based treatments and caregiver engagement.

Sexual Abuse in the Orthodox Jewish Community: A Literature Review

Sexual abuse is a cross-cultural phenomenon related to multiple cultural contexts including religious affiliation. The Haredi, or Orthodox Jewish community (OJC), constitutes a significant minority group of the worldwide Jewish population, characterized by cultural conservatism, steadfast loyalty to the community, and strict religious behavioral codes. To date, only few empirical studies (as opposed to multiple media reports) have dealt with the issue of sexual abuse within the OJC. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a systematic review of the literature on sexual abuse within the OJC and its subgroups that addresses experiences and reports of victims, perpetrators, the Jewish and general community, and professionals in the North America, Israel, and Australia. Articles were collected from peer-reviewed databases and bibliographies; 13 quantitative and qualitative articles were included in the final sample. Three themes emerged: disclosure of sexual abuse, perceptions and attitudes toward the abuse, and its implications. Results indicated that alongside several findings that were specifically grounded in the context of closed collective or religious societies and the OJC in particular, most essentially reflected universal aspects of sexual abuse. The results suggest promoting context-informed interventions based on community knowledge and resilience, together with appropriate training in order to better understand the needs of the OJC and of closed communities in general.

"It burns her more than it burns for me": The sibling subsystem in the context of child physical abuse as portrayed by children during forensic interviews

BACKGROUND

The sibling subsystem is a central and potentially protective factor for children. Nevertheless, in the context of child abuse, it remains surprisingly understudied.

OBJECTIVE

The current study was designed to examine how children referred to a forensic interview following suspected physical abuse experienced and perceived the sibling subsystem.

PARTICIPANTS AND SETTING

The sample included 60 forensic interviews with children, aged 4 to 14. Each child had at least one sibling and referred to this sibling in the context of the abuse they experienced.

METHODS

Thematic analysis was carried out on the narratives provided by the children. Several steps were taken to ensure the trustworthiness of the study, with four criteria: credibility, transferability, dependability, and confirmability.

RESULTS

The main theme identified was physical abuse as a familial routine. This abusive routine was sometimes perceived as normal and sometimes traumatic, with descriptions of fear and physical pain. The children addressed the various figures in this abusive routine. When these horrific daily experiences were elaborated on, the children often captured the sibling subsystem as a source of security, comfort and protection. Moreover, the children's language often communicated the siblings' bond, referring to "we" and "us." Within a few narratives, a split between the siblings was identified, which appeared to be a strategy of self-protection by going against their siblings.

CONCLUSION

The current findings join the recent accumulating evidence with respect to the centrality of the sibling subsystem in the experiences and consequences of child abuse. It is imperative to advance practitioners' knowledge and interventions to better adapt to the central role of the sibling subsystem in the context of child abuse.

"I Love and Hate Him in the Same Breath": Relationships of Adult Survivors of Sexual Abuse With Their Perpetrating Siblings

The term sibling sexual abuse (SSA) captures a broad continuum of sexual behaviors in childhood and adolescence that exceed the threshold of age-appropriate curiosity. Based on a sample of 15 adult survivors of SSA, this qualitative study examines experiences of relationships with perpetrating siblings during childhood and adulthood. Thematic analysis of semistructured qualitative interviews reveals two continua that characterize SSA survivors' lives: the "reciprocity-coercion" continuum in childhood and the "distance-closeness" continuum in adulthood. Findings reveal that regardless of how the relationships were perceived in childhood, most participants chose to distance themselves from their perpetrating siblings as adults. Thus, even in cases where the relationships were considered mutual during childhood, reconceptualization of the abuse in adulthood led to renewed understanding of its meanings and implications for the survivors' personal lives. Research findings underscore the need to further study the experiences of SSA survivors to better inform policy makers, therapists, and welfare workers, to address the complex and multifaceted nature of SSA, and to provide adequate interventions to survivors and other family members.

Money, Status, Love, and Death: Sexual Relations With Considerably Older Persons in African Societies-A Systematic Review

Sexual relations between adolescents or young persons and considerably older persons are considered illegal or deviant in many countries. Yet legal and social definitions and constructions do not capture the complexity of such relations and the various perspectives surrounding them, including that of those involved and other members in the community. In a previous publication, the author examined perspectives on sexual relationships between minors and older persons in Western societies. The current review broadens the perspective on this phenomenon by examining perceptions of sexual relationships between minors, young adults and older persons in African societies, using a similar approach informed by and adapted according to the unique sociocultural context of the articles reviewed. All samples were located in Africa. All studies were published in English. In the current review, the ages of the adolescents or young adults were higher than in the review of Western societies, up to 25, and the age gaps were higher as well. Three main themes emerged from the meta-analysis: adolescents and young adults' motivations to be involved in sexual relations with an older person, relationship characteristics as perceived by both partners, and the negative consequences of such relationships for the younger partner. The findings are discussed and implications for future studies and practices are suggested, highlighting the important role of sociocultural perceptions and calling for a more nuanced and intellectually modest understanding of the complexity of these relationships.

Preadolescent Peer Sexual Abuse: A Systematic Literature Review

Child sexual abuse (CSA) is a worldwide social problem which has received much attention from policy makers, researchers, and practitioners. A considerable portion of CSA research has focused on adult offenders, the result of which is that most of our existing knowledge regarding prevention and intervention has been based on abuse perpetrated by this population. The current literature review, by contrast, was designed to spotlight the phenomenon of preadolescent peer sexual abuse (PAPSA), focusing on children ages 12 and under, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The results revealed scant empirical data, with only nine studies focusing on this phenomenon. As the basis of their investigations, most of the reviewed studies used definitions of sexual harassment among peers, rather than definitions of more severe forms of sexual abuse, and showed conflicting results depending on the ages and genders of the peers involved. In addition, prevention programs for peer sexual abuse/harassment were not targeted toward preadolescents. Additional findings indicated a lack of empirical knowledge with respect to core aspects such as victims' personal characteristics and subjective experience, the dynamic of the abuse, and the disclosure process. This systematic literature review emphasizes the need for an in-depth and thorough conceptualization and empirical examination of the PAPSA phenomenon and its unique characteristics.

How does COVID-19 impact intrafamilial child sexual abuse? Comparison analysis of reports by practitioners in Israel and the US

BACKGROUND

There is consensus in child sexual abuse (CSA) literature that intrafamilial child sexual abuse (IFCSA) has a tremendous impact on children and families while simultaneously creating challenges for practitioners. COVID-19 impacted countries worldwide and generated a global crisis resulting in impacts on daily life, however, it's effect on IFCSA is unknown.

OBJECTIVE

This study aimed to compare professional perspectives and experiences working with IFCSA with respect to the context of the COVID-19 pandemic within the United States and Israel.

PARTICIPANTS AND SETTING

Participants were therapeutic, child welfare and legal professionals, who provided services to children involved in IFCSA.

METHODS

This qualitative cross-cultural comparative study analyzes professional experiences of IFCSA during COVID-19 based on an open-ended questionnaire answered online, with 37 responses from the US and 23 responses from Israel.

RESULTS

Findings reveal mostly negative changes in the dynamics of IFCSA families during COVID-19, including financial, environmental, and emotional hardships, as well as some positive changes in the relationships among family members. In terms of professional interventions, concerns were raised that COVID-19 has been detrimental to the disclosure of IFCSA, with plummeting child abuse reports. Further, risk and benefits of transferring to internet based or telephonic therapeutic interventions were shared.

CONCLUSIONS

Governmental and community efforts are needed to develop a safety net of protective factors to reduce IFCSA risks and increase resiliency during the COVID-19 pandemic and future global crises. Moreover, enhanced strategies to accessing and supporting families remotely such as using technology could improve identification and response to IFCSA.

My Brother's Keeper? The Sibling Subsystem in the Context of Physical and Sexual Child Abuse

The sibling subsystem is of central importance and a possible protective factor for children. Nevertheless, it remains surprisingly understudied and lacks any theoretical or conceptual framework. The current study explored the sibling subsystem in the context of child abuse (CA). Thorough thematic analysis was conducted on the narratives of 30 children referred to forensic interviews following suspected physical or sexual abuse by a parent. Aged 4-14, all had at least one sibling each and referred to this sibling during their interviews in the specific context of the CA they had experienced. Their narratives shed light on two dynamics that can characterize the sibling subsystem in the context of CA: compensation and spillover of the trauma into the sibling subsystem. They stress the centrality of the sibling subsystem in the children's lives and the siblings' role in the children's survival of CA. The current study's findings emphasize the urgency of continuing to develop studies in this area, as they will likely contribute to both prevention and intervention efforts.

"Victim, Perpetrator, or Just My Brother?" Sibling Sexual Abuse in Large Families: A Child Advocacy Center Study

Sibling sexual abuse (SSA) is a continuum of childhood sexual behaviors that do not fit the category of age-appropriate curiosity. Although SSA may be the most prevalent and longest lasting form of intrafamilial sexual abuse-as well as the one with the worst repercussions-it is also the least reported, studied, and treated. Based on 100 mostly religious Jewish families referred to a child advocacy center (CAC) in Jerusalem from 2010 to 2015, this qualitative study examines SSA characteristics, dynamics, and perceptions of deviancy in multisibling subsystems. The findings are based on an analysis of case summaries, demographic charts, and documented conversations between social workers and siblings. Qualitative document analysis reveals two types of SSA dynamics: "identified perpetrator" and "routine relationship," the latter being a particularly understudied dynamic that challenges common stereotypes. We also found sibling perceptions of deviancy to vary along a continuum from deviant to completely normative. These perceptions are affected by the type of dynamics as well as by factors associated with disclosure. Our findings highlight the importance of studying the lived experiences of children involved in SSA as an input with critical policy, treatment, and research implications. Interventions must be adjusted to the family system and sibling subsystem's perceptions and needs to avoid treatment that exacerbates the crisis already experienced by the family. Common assumptions-there must be a "perpetrator"; abuse is necessarily traumatic; and treatment should focus on the trauma-are challenged by the routine type. We conclude that treatment should account for the complexity of SSA by shedding these assumptions and considering the sibling subsystem as an autonomous unit within the large family.

Child Advocacy Center intervention with sibling sexual abuse cases: Cross-cultural comparison of professionals' perspectives and experiences

BACKGROUND

Despite being a complex phenomenon with potentially significant short- and long-term consequences for all involved including siblings, parents and the family as a whole, sibling sexual abuse (SSA) has not received sufficient empirical and clinical attention. Practitioners are often left to cope without appropriate guidance.

OBJECTIVE

This study aimed to compare staff perspectives and experiences of working with sibling sexual abuse cases across two Child Advocacy Centers (CACs) within different countries and different cultural and legal contexts.

PARTICIPANTS AND SETTING

Participants were staff members from two Child Advocacy Centers: one in Jerusalem, Israel, and the other in Montgomery County, Pennsylvania, United States of America.

METHODS

This qualitative cross-cultural comparative study analyzes staff experiences of sibling sexual abuse cases based upon 14 focus groups, in Jerusalem (N = 7) and Montgomery County (N = 7).

RESULTS

Findings reveal that both CACs focused on parents, the parents' negative emotional responses to SSA, and the impossible nature of their predicament. The Montgomery County CAC tended to emphasize the needs of the victim while being attuned to the legal proceedings, whereas the Jerusalem CAC emphasized supportive therapeutic responses for the whole family.

CONCLUSIONS

The differences across the two Child Advocacy Centers are related to the different legal and cultural contexts of the two CACs and underscore the need to review what may be the most appropriate policy and practice response to SSA that does not itself cause further harm.

Exemption committees as an alternative to legal procedure in cases of sibling sexual abuse: The approaches of Israeli CAC professionals

BACKGROUND

Sibling sexual abuse (SSA) is a widespread form of intrafamilial child sexual abuse frequently regarded as play or normal sexual behavior, and therefore highly underreported. Israeli law allows Child Protection Officers (CPOs) to suspend police intervention after the disclosure of SSA, and refer the family to therapy, by applying to an "exemption committee."

OBJECTIVE

This study will examine the characteristics of cases referred to the exemption committee or legal procedure and the justifications provided by CPOs to support the decisions.

PARTICIPANTS AND SETTING

The study was based on 40 family cases referred to the Child Advocacy Center in Jerusalem: twenty cases were referred to an exemption committee and the rest to legal procedure.

METHOD

Qualitative document analysis conducted on the two groups of cases (N = 40). Files were then analyzed using the thematic analysis approach.

RESULTS

During the decision-making process, CPOs assess each of the cases in a broad and holistic manner, basing their decisions on various contextual factors, including the characteristics of the survivor, the perpetrator, the parents and other siblings, and the types of sexual acts involved.

CONCLUSIONS

This comprehensive approach to understanding and handling the complex family story and nature of SSA underscores the need to address SSA and subsequent interventions - legal or therapeutic - not exclusively in terms of quantifiable criteria, but also in terms of a crisis involving the relationships in the entire family, past and future course of treatment, and the perceptions of family members involved.

Perspectives on Adolescent Sexual Relations With Older Persons: A Systematic Review of the Literature

Relations between minors under the age of consent and older persons are legally prohibited in many countries. However, the nature of these relationships, their impact on the lives of minors involved, and how they should be dealt by law enforcement and welfare systems are highly controversial. The differences between the way these relations are perceived by the minors involved and the public are also unclear. This literature review examines them as perceived by youths or young adults who had experienced sexual relations with a person at least 2 years older during their adolescence as well as by students and other adult members of the public. A systematic search of 977 studies initially identified as relevant yielded 16 studies that fit the inclusion criteria. Most (13) research samples were located in the United States, and the remainder were in the United Kingdom (2) and Australia (1). All were published in English. Four main themes emerged from the analysis of these studies: adolescent motives for sexual relations with older persons (two studies); characteristics of sexual relations between adolescents and older persons (6); contextual factors affecting the way such relations are perceived, including the partners' ages and genders (11); and perspectives on the legal framing of such relations (6). The studies' findings are discussed and implications for future research, policy, and practice are suggested, highlighting the complexity and ambiguity of the phenomenon and calling on intervention programs to focus on strengthening the family unit and social network of these youth and for policies to address teen sexuality as defined both normatively and legally.

Therapeutic interventions with child survivors of sibling sexual abuse: The professionals' perspective

BACKGROUND

Sibling sexual abuse (SSA) is a continuum of childhood sexual behaviors that do not fit age-appropriate curiosity. SSA may be the most prevalent, longest lasting form of intrafamilial sexual abuse - and the least reported, studied and treated.

OBJECTIVE

This exploratory qualitative study examined the experience of intervention with SSA survivors from the perspective of mental health professionals, and explored their major therapeutic challenges.

PARTICIPANTS AND SETTING

The sample consisted of 20 Jewish Israeli mental health professionals working in private clinics or public social welfare services who had experience with SSA.

METHODS

Semi-structured interviews focusing on the characteristics of SSA events, perceptions about the effects of abuse, intervention priorities and therapeutic challenges compared to other types of child abuse.

RESULTS

Professionals working with SSA survivors are preoccupied with the need to provide them with physical and emotional protection, as well as to help them process the abuse narrative. They also find themselves dealing with survivors who do not experience themselves as victims despite external evidence of abuse, or with the need to reconcile their perception of the sexual relationship as mutual, as opposed to the formal requirement to differentiate between "offender" and "victim". In either case, the reality of these survivors can be just as painful as in other SSA cases.

CONCLUSIONS

The complexity of SSA calls for unique intervention skills, including working with survivor narratives that do not fit the victim/offender dichotomy on one hand and that do not minimize the potentially harsh consequences of SSA on the other.

Parental attitudes following disclosure of sibling sexual abuse: A child advocacy center intervention study

Sibling sexual abuse (SSA) represents a range of childhood sexual behaviors that cannot be considered manifestations of age-appropriate curiosity. Despite being the commonest and longest lasting form of sexual abuse within the family, SSA is the least reported, treated, and researched. This qualitative study is based on a sample of 60 mostly religious Jewish families referred to a child advocacy center (CAC) in Jerusalem from 2010 to 2015. It examines parental attitudes to SSA and their reconstruction, during and after their experience at the CAC. Analysis of case summaries and documented conversations between child protection officers and parents reveals 2 main initial parental attitudes after the disclosure SSA. The first is the attitude that no sexual acts took place at all. The second is that they did occur, with 3 different variations: the sexual acts as "not serious," as a "rupture in the family's ideal narrative," and as "another tragic episode in the family's tragic life story." Findings also suggest that the CAC intervention is a turning point, leading most parents to reconstruct their initial attitudes from "never happened" or "not serious" to "rupture in the family image" or to "another negative event in the family." These findings underscore the need to study the experiences of parents whose children were involved in SSA to inform policy, treatment and research. This is critical, as interventions that are not aligned with family attitudes and needs are known to exacerbate the family crisis. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

The Secret of Intrafamilial Child Sexual Abuse: Who Keeps It and How?

This article analyzes how women survivors of intrafamilial child sexual abuse perceive the family members who took part in keeping it secret and their tactics for doing so. Analysis of 20 in-depth interviews with Jewish Israeli women revealed unique ways of guarding the secret. These were attributed to the perpetrator, the mother and the family. Secret-keeping tactics included presenting a normative public identity or an unstable psychological identity, presenting multiple personas, reframing the abuse, concealing any trace of the secret after it was disclosed, as if the abuse had never happened, and making a monument of the abuser. These tactics are discussed in the context of silencing, the interpersonal relations orientation model, and the wider concepts of secrecy in society. Implications for professional practice and for society are considered, and new attitudes toward intrafamilial child sexual abuse secrecy are suggested.

Torn: Social Expectations Concerning Forgiveness Among Women Who Have Experienced Intrafamilial Child Sexual Abuse

The authors examine how women who experienced intrafamilial child sexual abuse (IFCSA) perceive social expectations of society toward forgiveness, how they incorporate IFCSA and reconstruct their life stories in relation to these expectations, and the costs and gains from such reconstructions. This is part of a larger study on the phenomenology of forgiveness for IFCSA among grown women. Twenty Jewish Israeli women who had experienced IFCSA were interviewed in depth. Interviews were tape-recorded and transcribed verbatim. Data analyses lead to four types of social expectations: forgiveness by forgetting, avenging, family preservation through forgiveness, and satisfying the voyeuristic needs of society, which has limited interest in forgiveness. These contradictory expectations are discussed in light of the cultural context and the experience of the women interviewed. Implications for practice are suggested.

Adult women survivors of intrafamilial child sexual abuse and their current relationship with the abuser

This article examines the adult perceptions of women survivors of intrafamilial child sexual abuse and their current relationship with the family member who abused them in their childhood. Twenty Jewish Israeli women were interviewed in depth between 2008 and 2009. Interviews were tape-recorded and transcribed verbatim. Data analysis produced 2 interrelated continua with regard to the presence of the perpetrator in the women's life: a continuum of his actual daily presence in the woman's living space, ranging from complete absence to a continuous presence, and a continuum of his experiential presence, ranging from a high level of intrusiveness to encapsulation and total dissociation. The 2 continua are discussed and implications for practice are suggested. (PsycINFO Database Record

Seriously clowning: Medical clowning interaction with children undergoing invasive examinations in hospitals

This qualitative study examined the subjective experience of children undergoing an invasive examination in the hospital when accompanied by a medical clown. In-depth semi-structured interviews were conducted with nine such children and nine of their accompanying parents. The children were patients in two outpatient departments (Pediatric Gastroenterology and a Center for the Sexually Abused) in a hospital in Israel. Interviews were coded thematically using an Atlas.ti software program. Analysis of the interviews indicated that the intervention of the clown positively changed the children's perceptions of the hospital, of experiencing the examination, and of their life narrative. Medical clowns thus appear to be a central, meaningful, and therapeutic source for children undergoing invasive examinations in hospital, as well as for their parents. Therefore, it may be advisable to incorporate medical clowns as an integral part of medical teams performing invasive procedures and to include the clowns in all stages of the hospital visit.

The Therapy Beneath the Fun: Medical Clowning During Invasive Examinations on Children

OBJECTIVE

The qualitative research presented here is part of a larger project on the significance of medical clowning during invasive examinations in children in the Department of Gastroenterology and the Center for the Sexually Abused in a hospital in Israel. It investigated what makes up the essence of medical clowning, what skills and techniques are used by medical clowns, and whether their work contains therapeutic elements.

METHODS

A total of 9 children undergoing invasive examinations and 9 of their accompanying parents participated in semistructured interviews, which were analyzed using a thematic analysis methodology assisted by an Atlas-ti software program.

RESULTS

The interviews revealed that the medical clowning intervention during invasive examinations was essentially therapeutic, with the clown using theatrical and clowning tools to incorporate therapeutic elements such as empowerment, reversal of role, reframing, and building a therapeutic alliance. In addition, during the invasive examinations, the medical clowning followed the model of brief crisis intervention therapy.

CONCLUSION

The study advances the need to incorporate medical clowns as an integral part of medical teams performing invasive procedures and to include clowns in all stages of the hospital visit when children undergo invasive examinations.

Adult Disclosure of Child Sexual Abuse: A Literature Review

Victims of childhood sexual abuse carry the experience of abuse into adulthood. One of the dilemmas victims face during adulthood is the decision to disclose or conceal the abuse. Although adult disclosure may be affected by former disclosure during childhood, adult survivors face new challenges and dilemmas, such as to whom, when, and how to tell. The purpose of this article is to review the domains found in the literature on survivors' experiences regarding disclosure of child sexual abuse during adulthood, all of which were published between 1980 and 2013. Domains include decisions to disclose during adulthood, barriers and facilitators to disclosure and potential recipients of the disclosure, as well as the process of telling and its impact on survivors' well-being. The authors present implications for policy, practice, and research.

"It all depends on the guy and the girl": a qualitative study of youth experiences with statutory victimization relationships

The purpose of this exploratory study was to examine youths' perceptions of statutory victimization relationships and youths' experience interacting with professionals. In-person qualitative interviews were conducted with 22 youths identified as statutory rape victims by two child advocacy centers. Using grounded theory, interviews were coded thematically using constant comparison analysis. The discussion of the relationship dynamics suggested a great deal of variation. Some youths described the relationships in exploitive terms. However, more typically, the interviewed youth described the relationship as reciprocal, even some time after it had ended. The professional intervention often resulted in feelings of helplessness for the youth. The results suggest creative and flexible protocols are needed for handling these cases that recognize adolescents' developing autonomy.

Laughing through this pain: medical clowning during examination of sexually abused children: an innovative approach

This study examined the role of medical clowns during medical examinations of children who were sexually abused. Three case studies are described, illustrating diverse interactions among the victimized child, the medical clown, and the medical forensical examiner during medical forensic examinations held at the Tene Center for Sexually Abused Children, Poria-Pade Medical Center, Israel. The results indicated that medical clowns play a unique role both in lowering anxiety and fear among children before and during the unpleasant forensic examination as well as in mitigating potential retraumatization of the sexual abuse event resulting from the medical examination. The medical clown was found to assist in creating a pleasant and calm atmosphere, thus improving the child's cooperation during the examination.