Thesis (Ph. D.)--Carleton University, 2001. / Includes bibliographical references (p. 293-308). Also available in electronic format on the Internet.

Dissertation (Ph.D.)--The University of North Carolina at Greensboro, 2009. / Directed by Williams Cowling; submitted to the School of Nursing. Title from PDF t.p. (viewed May 17, 2010). Includes bibliographical references (p. 200-237).

Thesis (M.Soc.Sc.)--University of Hong Kong, 1998. / Includes bibliographical references. Also available in print.

Structural equation modeling was used to examine how childhood sexual abuse (and other associated variables, such as family functioning and experiencing multiple forms of abuse) relates to revictimization and psychological distress. Participants were women who participated in Project HOW: Health Outcomes of Women interviews, a longitudinal study that spanned six waves of interviews. Only women with a history of childhood sexual abuse were included in the present study (n=178). Experiencing nonsexual child maltreatment in addition to childhood sexual abuse appears directly related to adult sexual and physical revictimization and indirectly related to psychological distress. Childhood sexual abuse alone was not predictive of revictimization or psychological abuse. This suggests that other mediating factors may explain the relation between CSA and revictimization found in other research. Clinical implications based on the results of the present study emphasize the importance of identifying children who have experienced multiple forms of abuse as particularly at risk for future victimization. In addition, providing interventions with a focus on education and empowerment might decrease risk for future violence and subsequent emotional maladjustment. Potential future research could examine the treatment outcomes and efficacy of these interventions as well as identify those mediating factors that increase the risk for adult revictimization for those individuals who experience only childhood sexual abuse.

This study explored children’s experiences and perceptions of adults and child-adult relations and relationships. Child-adult relations involve the conceptualisation of adults and children as distinct social groups and child-adult relationships are inter-personal relationships between individuals that cross the boundary between these groups. The focus of this study was children’s contacts and relationships with adults and how these relationships informed children’s constructions of child-adult relations. The study took place in the context of concern about distance between child and adult worlds generating negative stereotypes and distrust between the two social groups and an interest in children’s perspectives. A multi-stage, multi-method study was undertaken with children aged 10/11 years living in the relatively deprived, ‘Social Inclusion Partnership’ (SIP), areas of a Scottish city. A period of familiarisation, through participant observation, was undertaken with Year 6 children in one school, followed by paired and individual interviews with 17 children. A survey was then conducted with 375 children in primary schools across the SIP areas. In general it seemed that ‘relationships’ with individual adults, other than with parents, were not particularly important to the children, who, with a few exceptions, did not seek out such adults and generally indicated a preference for spending time with other children. However, knowing and being able to identify adults within and beyond their families was very important to children’s sense of self and to their feelings of belonging to a family and within a neighbourhood. The children did experience their worlds and those of adults as separate. Mobility beyond their neighbourhood without adult accompaniment, to visit swimming pools, cinemas, and retail facilities, provided children with opportunities to observe and experience a range of ‘unknown’ adults, and particularly ‘public workers’. This experientially confirmed their conceptualisations of adults as a separate social group occupying a higher status than children. The research process in itself indicated that in some circumstances children did have an interest in interacting with adults, and that time, negotiation, testing and trusting were part of the relationship forming process. The child-adult relationships formed in this study through engagement in ‘joint enterprises’, of play and research project, provide evidence for the possibilities of positive ‘generational proximity’ between children and adults.

This research project aims to explore the role of the Key Person in Early Years preschool and nursery settings. The Key Person role is specified in the Early Years Foundation Stage (EYFS) guidance, and aims to provide an adult figure with which the children can form a positive and productive learning relationship. The present study originated from previous research conducted in the same authority which looked at the experiences of children in day care settings (Day, 2010). Day (2010) identified children’s attachment needs in day care settings as being an avenue for further research, and it was from this that the present study developed. The current study seeks to understand the role of the Key Person in terms of how relationships are formed with children in Early Years settings, and what those relationships look like on a daily basis. This is an important line of enquiry, as an understanding of Early Years, adult-child relationships can help inform effective future practice for Early Years staff, as well as enable outside professionals (such as Educational Psychologists) to design more effective means of early intervention for the children who may need additional support. The theoretical foundations for this research lie in attachment theory (Bowlby, 1969), following the language used by the Government Guidance on the role of the Key Person. Attachment theory is used here as a basis for understanding early adult-child relationships, and the review of the literature looks at research that has explored the impact of children’s attendance in day care settings. The project is divided into two linked research papers. In the first paper, the role of the Key Person is explored through surveying and interviewing a sample of Early Years staff. In doing this, the following research objectives were addressed: • To examine the approaches that Key Persons use to form relationships with the children in their care. • To explore Key Persons’ perceptions of their role within the setting and the challenges they face. • To examine the awareness and impact of the current government guidance on Key Person practice. • To examine how settings organise and evaluate the Key Person role. In the second paper, the relationships between the Key Persons and the children they care for are explored through a series of case studies. This was in order to address the following research objectives: • To explore the relationships between particular children with adults in Early Years settings through intensive case studies. • To examine the Key Person-child relationship by comparing Key Person-child interactions with interactions with other adults in the setting. • To compare cases of Key Person-child relationships between children who have identified social or emotional needs and those who do not. The findings from paper one indicated that Key Persons do not generally seem to use the Government Guidance as a primary influence on the way they build positive relationships with their Key Children. Key Persons seemed to base their practice on experiential knowledge. Furthermore, the organisation of the role in most settings seemed to indicate a more administrative focus than a focus on building specific relationships. Paper two showed that Key Persons generally had more interactions with their Key Children than other adults had with the same children. Differences were found in the types of interactions children experienced with different adults. Relationships were reported to be close with both groups of children, with Key Persons reporting more conflict with the children identified with social or emotional needs. It is hoped that the findings of the two linked papers will inform EP practice in relation to Early Years settings, particularly in terms of developing early intervention. From professional experience, there seems to be a large amount of diversity in the way EP services work with preschool-aged children and the professionals who support them. Perhaps further uses for the findings in this research could be to inform future collaborative working, as well as areas to which EPs can contribute their body of research knowledge. The following document presents each study separately as individual papers, each with appendices which contain additional information on methods and data analysis. The papers are followed by the literature review, university Ethics form and the bibliography for the entire study.

This thesis reports on a discourse analysis of thirteen qualitative interviews with male survivors of sexual abuse. My analysis focuses on participants' changing experiences and understandings of what it means to be 'masculine', and how they saw these having been influenced by the experience of being abused. An important finding was that many participants expressed concern regarding their invisibility as male survivors, noting that contemporary discourses on violence typically position men as its perpetrators, rather than its victims. I analyze the significance of the absence of a discourse of male victimization in terms both of its practical implications for male survivors and its theoretical implications for critical work on hegemonic masculinity. Based on the premise that hegemonic masculinity is a cornerstone of patriarchal systems, I conclude by using the experiences of my participants as a means of exploring the potential for men to experience 'oppression' under patriarchy.

Thesis advisor: James Lubben / Thesis advisor: Sara M. Moorman / Every year, more than three million allegations of childhood maltreatment are received by child protective services, many of which involve cases of abuse or neglect inflicted by the victims’ parents. A number of studies found that negative consequences of childhood maltreatment can last for a lifetime. Despite the long-term impact of childhood maltreatment, later-life relationships between adult victims of childhood maltreatment and their abusive parent have rarely been examined. This dissertation aims to address the gap in the literature by examining how adult victims of childhood maltreatment relate to their abusive parent when the parent becomes old and requires long-term care assistance. This three-paper dissertation utilized existing data sources: Wisconsin Longitudinal Study and National Survey of Midlife Development in the United States. The first paper examined the mediating effect of intergenerational solidarity with the aging mother in the association between maternal childhood maltreatment and adult psychological functioning. The second paper used longitudinal data analysis to compare long-term changes in affectual solidarity with aging mothers between adults with a history of childhood abuse and those without. This paper also examined moderating effects of the correlates of childhood abuse (i.e., poor social competency and lack of emotional regulation) in the association between childhood abuse and affectual solidarity with the aging mother. The third paper focused on the caregiving situation in which adult victims of childhood abuse provided care to their abusive parent. This paper investigated whether and how providing care to the abusive parent was associated with psychological distress among abused adult children, and whether self-esteem mediated the association. By revealing the dynamics of later-life relationships between adult victims of childhood maltreatment and their abusive parent, this three-paper dissertation not only contributes to creating new knowledge to the aging literature, but also provides future direction for social work practice and policy. / Thesis (PhD) — Boston College, 2016. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.

Childhood abuse, whether physical or sexual, is a major public health issue. The most recent United States data from Child Protective Services (CPS) show that in 2013 there were 3.5 million referrals of child maltreatment involving 6.4 million children. Out of these cases, 18% were for physical abuse and 9% were for sexual abuse. However, researchers argue that CPS data grossly underestimate the prevalence of childhood abuse as most childhood abuse goes unreported. Indeed, to date, the true prevalence of childhood abuse remains unknown as research has been hampered by inconsistent definitions of abuse and wide variation in methodologies including measures for its identification and modes of administration of these measures. Although a health care visit presents an opportunity to identify a childhood abuse history, health care providers frequently fail to ask about it. The reasons doctors give for not asking about abuse include lack of training, not knowing how to ask, and lack of familiarity with practical methods for screening that can be used in primary care settings. There is little to no research on effective means for identifying childhood abuse histories, especially in the adolescent and young adult population, or on how different modes of administration of screens to identify childhood abuse compare to each other. The net result is that most childhood physical and sexual abuse is never identified and many victims do not get the needed services to help them heal. When unaddressed, childhood abuse has negative impacts on victims’ health and wellbeing over the life course. Prior studies of adults show that when compared with non-victims of abuse, victims tend to perceive their health as poorer and utilize more health care services including emergency room and urgent outpatient care. These studies also suggest that adult victims use less routine and preventive care than non-victims. Only two studies, conducted among widely different adolescent populations, have examined how adolescent victims perceive their health. Similarly, limited evidence examining perception of health is available for young adults. These studies found that victims perceive their health as poorer than non-victims. There have been no adolescent-specific studies of how victimization impacts adolescents’ utilization of health care. One study includes participants ages 15 to 98 years and only two studies focusing on this issue in samples primarily of young adults attending college have been published. These studies found that victims utilize more health care than non-victims. Therefore, we lack a sufficient body of evidence to come to clear conclusions of how childhood abuse affects self-perceived health in adolescents and young adults. The general lack of evidence about both how childhood abuse impacts perception of health and utilization of health care in adolescents and young adults indicates a need for further study. Given that little is known about how to best identify an abuse history in adolescents and young adults and the impact of abuse on perception of health and utilization of health care, this dissertation pursued three aims: (1) to review the literature comparing modes of administration of screens to identify adolescent and young adult victims of childhood physical and sexual abuse; (2) to investigate how different modes of administration of screens to identify adolescent and young adult victims of childhood physical abuse within a primary care health setting compare to each other, and; (3) to examine the association of a history of childhood abuse (defined as none, physical only, and sexual with or without physical) with perceived health status and the health care utilization patterns among adolescents and young adults. For aim 1, a comprehensive literature review was conducted via PubMed of studies, published between January 1st, 1994 and December 31st, 2014 that compared modes of administration of screens to identify a history of childhood physical and sexual abuse in adolescents and young adults. Only one study was found. This study compared paper and pencil questionnaire, computer assisted survey, and face to face structured interview in the identification of childhood physical and sexual abuse among young adults in a college setting. No significant difference in the proportion of childhood physical abuse or childhood sexual abuse was identified by mode of administration. The identification through this search of only one study – which was conducted among college students, with no studies done among adolescents – shows a significant gap in our knowledge regarding this issue. Given that understanding how to identify childhood abuse is a critical issue, this gap is disturbing and underscores the need for studies of identification of childhood abuse to be a research priority. For aim 2, a sample of participants, ages 12-24 years, receiving health services at the Mount Sinai Adolescent Health Center in New York City were randomized to one of four modes of administration to identify a history of childhood physical abuse. The four modes of administration of screens to identify childhood abuse were paper and pencil screen, Audio Computer Assisted Self Interview screen (ACASI), face to face structured screen and face to face unstructured interview. The full sample also completed measures to assess demographic characteristics and to screen for depression symptoms. Of the sample, 44.5% of the participants disclosed childhood physical abuse. There was a statistically significant difference in the proportion of childhood physical abuse identified according to mode of administration: face to face unstructured interview identified the highest proportion of childhood physical abuse victims, followed by face to face structured screen. After adjusting for age, gender, race/ethnicity, depression, living arrangement and last grade completed, the odds of identifying physical abuse was 1.6 (95%CI: 1.0, 2.7) and 4.5 (95%CI: 2.6, 7.8) greater for face to face structured screen and for face to face unstructured interview, respectively as compared to paper and pencil screen. ACASI and paper and pencil were similar to each other but inferior to the face to face methods. For aim 3, in addition to what was measured for aim 2, the sample completed measures on a history of childhood sexual abuse and perceived health and health care utilization. The sample was then categorized into three groups: no abuse, physical abuse only, and sexual abuse with or without physical abuse. The association of childhood abuse status with perceived health and health care utilization were examined. There was no statistical significant association between a history of childhood abuse status and perceived health. However, the odds of reporting a fair/poor perception of health among those reporting childhood abuse were at least 40% lower regardless of whether the abuse was physical (OR: 0.60; 95%CI: 0.3,1.2) or sexual (OR: 0.50; 95%CI: 0.2,1.1). No significant association was found between childhood abuse status and health care utilization. However, the odds of victims reporting using urgent care only versus routine care only were at least 10% lower regardless of whether the abuse was physical (OR: 0.50; 95%CI: 0.3, 1.1) or sexual (OR: 0.90; 95%CI: 0.4,1.9). The odds of reporting using both urgent and routine care versus routine care only was similar between victims and non-victims for physical abuse (OR: 1.0; 95%CI: 0.6, 1.5) and was 30% higher for victims of sexual abuse (OR: 1.3; 95%CI: 0.8, 2.2). The findings from the three aims examined identified significant gaps in our knowledge on childhood abuse among adolescents and young adults suggesting an urgent need for further research. While much research has focused on the impact of childhood abuse on health and well-being, aim 1 reveals that little is known about which mode of administration of screens to identify childhood abuse is most effective in the identification of childhood abuse in adolescent and young adults. Furthermore, we know even less about what modes of administration of screens might be practical in primary care settings, or what must be done to improve the level of screening for childhood abuse by physicians and other health care providers. Although the findings from aim 2 suggest that face to face modes of administration are most effective in screening for childhood physical abuse in primary care settings, further studies are needed to support these findings. In addition, there is a need for studies that examine what are the best methods to use to identify childhood sexual abuse in primary care settings. The findings from aim 3 suggest that adolescents and young adults with a history of childhood physical and sexual abuse, receiving health care at the Mount Sinai Adolescent Health Center, do not perceive their health as worse than non-victims nor do they appear to utilize health care differently from non-victims. These findings contrast with results from prior studies of perceived health status and health care utilization among adolescents and young adult childhood abuse victims. Understanding how abuse impacts both the perception of health and health care utilization will be crucial in the development of interventions to identify and support adolescent and young adult victims of childhood physical and sexual abuse.

In the past decade there has been growing recognition that a sexual abuse history may manifest during health care examinations. More recently, awareness has been raised about a possible link between a history of sexual abuse and traumatic labour and birth. It is theoretically likely that the intimacy of labour and birth for women with a history of sexual abuse may trigger post-traumatic stress symptomatology. In this cross sectional study, a survey method was used to establish prevalence of sexual abuse and to measure obstetric outcomes, birth experience and birth trauma in a cohort of women who have recently given birth and to test whether there are associations between sexual abuse and birth outcomes. Eighty-five women whose 3½ to 5 year old children attend kindergarten participated. Lifetime sexual abuse was found to be a common experience for study participants. One out of every three women disclosed an experience of sexual abuse in her lifetime. A history of sexual abuse was not associated with adverse labour and birth outcomes; however women with a positive sexual abuse history were more likely to report postnatal depression. A quarter of the women had PTSD symptoms but overall, women had positive birth experiences and felt well supported. Many women are able to overcome traumatic abuse experiences and successfully cope with birth, an event that may potentially replicate the dynamics of sexual abuse. Further research is needed to identify women who may be at high risk for traumatic birth experiences. Undertaking screening for sexual abuse in the antenatal period in a safe environment may provide reassurance for women and enable identification of those women at high risk for abuse related traumatic birth experiences.