ChildAbuse& Ne@c~ Vol. 14. pp. 347-355. Printed in the U.S.A. All right.5 rrSerVcd.

1990 Copyright

0145-2134/9053.00+.00 Q I990 Pergamon Press plc

PATTERNS OF CHILD SEXUAL ABUSE KNOWLEDGE AMONG PROFESSIONALS ROBERTA A. HIBBARD Department of Pediatrics, Indiana University School of Medicine

TERRELL W. ZOLLINGER Indiana University School of Public and Environmental Affairs

Abstract-To better understand knowledge and perceptions of child sexual abuse, a survey was conducted of 902 professionals attending child sexual abuse educational programs during 1986-1987. About half (50.8%) of the group reported seeing at least two child sexual abuse cases a month, while 20.5% reported seeing five or more. Almost half (48.9%) of the respondents reported previous formal training regarding child sexual abuse. Professionals were generally knowledgeable about child sexual abuse; however, at least 20% ofthe professionals were not knowledgeable about some items that are important in the identification of child sexual abuse and that might hamper the legal and medical investigation of a case. Those with formal training, more years of professional practice, and who see five or more victims per month answered more questions correctly, but the differences were not always statistically significant. Further training for both medical and non-medical professionals is needed to ensure appropriate care of child sexual abuse victims and to improve communication and coordination of efforts between professions. Key Words-Child

sexual abuse, Professional knowledge.

INTRODUCTION INCREASED AWARENESS of the problem of child sexual abuse has resulted in increased numbers of children presenting to both medical and non-medical professionals for the evaluation of possible sexual victimization. Proper evaluation is critical to appropriately initiate early intervention and remediation, which in turn may prevent adverse long-term consequences, including subsequent injury or even death, to the child and his or her family (Orr & Prietto, 1979). Although all states in the USA now have child abuse reporting statutes, unknowledgeable professionals may fail to observe key markers that would indicate possible sexual or physical abuse (B&ton, 1987; Ladson, Johnson, & Doty, 1987; Orr, 1978; Willis & Horner, 1987). Even if they suspect a case should be reported, they may fail to report the case and involve other professionals, especially if the case is considered minor (Chang, Oglesby, Wallace, Goldstein, & Hexter, 1976; Finkelhor, 1984; Morris, Johnson, & Clasen, 1985; Saulsbury & Campbell, 1985). Recent evidence indicates both medical and non-medical professionals have some degree of general knowledge relating to child abuse; however, there may he some specific lack of understanding regarding the indicators of child abuse in general, and child sexual abuse in This project was supported by Indiana State Board of Health Project #290, 1985-1987. Received for publication December 14, 1987; final revision received October 2, 1989; accepted October 3, 1989. Reprint requests should be addressed to Roberta A. Hibbard, M.D., Department of Pediatrics, I.U.M.C. Riley Clinic C, 702 Ramhill Drive, Indianapolis, IN 46202. 347

348

Roberta A. Hibbard and Terre11W. Zollinger

particular, as well as other important related factors (Eisenberg, Owens, & Dewey, 1987; Ladson et al., 1987; Rosonke & Pelton, 1982). The recent addition of formal training on child sexual abuse, both as part of the professionals’ academic experience and as continuing educational efforts, have improved the professionals’ knowledge in a measurable degree (Hibbard, Serwint, & Connolly, 1987; Winefield & Castell-McGregor, 1986; Woolf et al., 1988). These same studies have also concluded that the level of knowledge is still inadequate and that more training is necessary. In fact, most professionals are aware of a need for more training (Attias & Goodwin, 1985; Rosonke & Pelton, 1982; Winefield & Castell-McGregor, 1986). The medical and non-medical professionals who provide care to the victims of child abuse share definitions and perceptions of child abuse because all share a common set of societal functions to monitor, detect, and control violence directed at children. However, differences in level of knowledge of child abuse have been noted across professions because of their occupational socialization (Lena & Warkov, 1978) differences in the specific training for the discipline (Attias & Goodwin, 1985) a lack of interaction between the professionals (Finkelhor, 1984) and professional experience relating to child abuse (Hazzard & Rupp, 1986). A survey was conducted of social, legal, and medical professionals attending day-long multidisciplinary seminars on child sexual abuse to identify specific issues that are not well understood by these professionals. In addition, differences in child sexual abuse knowledge and perceptions by professional group, level of experience, and reported formal training were documented.

METHOD Subjects Physicians, nurses, child protective workers, lawyers, law enforcement officers, and psychologists who professionally interact with child sexual abuse cases were invited to participate in a professional educational program on child sexual abuse. They were identified through state and local child protective services (CPS), hospitals, law enforcement agencies, newsletters, medical and legal professional society memberships, and personal professional contacts. In 15 geographic areas in Indiana, 1,148 of those invited attended day-long multidisciplinary educational programs on the evaluation of alleged sexual abuse victims. These programs, conducted during 1986 and 1987, were an outreach effort from an educational program previously reported (Hibbard et al., 1987). There were no requirements or fees for participation. Procedure Subjects were asked to respond to questions regarding previous experience and formal training in the evaluation of alleged sexual abuse victims and their knowledge about child sexual abuse. Formal training relating to child sexual abuse might include specific educational components in professional training programs, community-based educational programs, continuing educational programs, or child protective programs. The questionnaires were administered the morning of, but prior to, the program. The knowledge items were adapted from Hazzard’s work with professionals (teachers, physicians, mental health professionals) and assessed agreement with facts about reporting, dynamics, epidemiology, medical and psychological sequelae, and legal issues in child abuse (Hazzard, 1984; Hazzard & Rupp, 1986). Although Hazzard’s instrument dealt with child abuse in general, the items selected for this study were those specific for child sexual abuse. Subjects responded to 14 items on a 5-point

Patterns of child sexual abuse knowledge Table 1. Percent Responding

Correctly

as to the Accuracy

Statement Most sexual abuse of children involves physical force. (False) Children who have been sexually abused usually tell someone soon after the abuse. (False) Professionals who report a case of suspected child sexual abuse can be sued if the case is not substantiated in court. (False) Most fathers who sexually abuse their daughters are likely to abuse other children or rape adult women. (False) Children who are sexually abused may have positive feelings about the experience at the time. (True) In most cases, children who are sexually abused are abused by strangers. (False) Most adults who sexually abuse children were abused in some way as children. (True) Most sexual abuse of children includes intercourse. (False) The Child Protective Services investigates only reports of child sexual abuse made by professionals. (False) A professional must have physical evidence of child sexual abuse before reporting the case to Child Protective Services. (False) Many runaway children and adolescents have been sexually abused before running away. (True) Children who may have been sexually abused do not need medical examinations if the abuse occurred more than 72 hours before the child told someone. (False) A sexually abused child may have a normal physical examination. (True) Sexually transmitted diseases (venereal warts, gonorrhea, herpes) in children usually come from sources other than sexual contact. (False)

349

of the Sexual Abuse Knowledge

Statements

by Profession

Total Group N=902

Registered Nurses N=202 (p value)*

Law Enforcement N= II8 (p value)*

Social Workers N=236 (p value)*

71.6

68.0 (0.225 1)

67.5 (0.3450)

78.3(0.0129)

88.5

91.9(0.0189)

78.9 (0.0012)

90. I (0.2459)

78.5

76.8 (0.57 13)

86.8 (0.0270)

81.9(0.1658)

65.4

60.3 (0.0936)

65.8 (l.0000)

73.0 (0.0074)

47.8

41.2 (0.041 I)

41.2(0.1593)

53.5 (0.0533)

95.9

96.0 ( I .OOOO)

93.9 (0.3769)

97.4 (0.2541)

87.5

88.3 (0.8145)

86.7 (0.8848)

90.7 (0. I 173)

74.9

73.2 (0.5973)

67.5 (0.0669)

77.8 (0.2874)

93.3

93.8 (0.8327)

85.8 (0.0025)

99.0 (0.000 I)

88.3

87. I (0.6676)

86.8 (0.738 I)

95.0 (0.0004)

75.0

7 I .6 (0.28 13)

71.7 (0.4961)

80.6 (0.0263)

86.8

84.5 (0.3203)

80.9 (0.0754)

92.7 (0.0042)

74.2

84.9 (0.0002)

60.6 (0.00 I I)

74.5 (0.95 I I)

85.4

83.8 (0.5902)

76.4 (0.0086)

92.7 (0.0005)

* Adjusted chi-square comparing those in this category with those not in this category.

Likert scale. The 14 items are listed in Table 1 along with an indication of whether the statement is true or false. Strongly agree was the most correct response on four questions and strongly disagree wqs the most correct response on the other ten questions. A total score was developed by summing the values of the responses to each question so that a higher score reflected more correct responses. When analyzing individual items, responses were re-coded as correct (strongly or slightly) or incorrect (neutral, slightly, strongly). RESULTS The experience and practices of professionals attending the programs were described and differences were examined among professional groups using contingency tables (chi-square)

350

Roberta

A. Hibbard and Terre11 W. Zollinger

Table 2. Reported Formal Training Relating to Child Abuse and Neglect, Number of Victims Seen, Years of Practice, and Knowledge Scores by Profession

Profession

( :Y)

Medical: Medical Doctors (3% Nurses (‘02) Nonmedical: Attorneys (20) Law Enf~~rccment t 118) Psychologists (57) Social Workers (736) aOthers DitTercnce h! Profession ~___.._ a Administrat(~rs.

Percent Seeing Five

With Formal ‘I’raining

or More Victims Per Month

44.7 31.7

2.9 5.9

18.8 14.5

84.7 82.6

40.0

16.7

65.4 49. I

28.3 21.3 34. i 16.0

10.5 10.3 10.2 7.0 6.2

80.4 80.6 X5.1 85.0 x1.7

67.4 37.0

--teachers.

Percent

rnlllistcrs.

x A - 70.2 1’ i 0.000

xz 2 II2.I p < 0.000

Mean Number of Years in Practice

I.‘ = 28.37 1) i 0.000

Mean Percent Child Abuse and Neglect Knowledge Score

F = 7.76 p cc 0.000 ____II

c~~rnmunit~ service volunteers

analysis. Responses of the groups to the individual questions were also compared using contingency analysis and analysis of variance for the total score. The Yate’s correction of the chisquare test was used to compare responses in the analyses of 2 X 2 contingency tables. Completing the questionnaire were 902 subjects (response rate = 78.6%): 236 social work professionals (predominantly child protective services caseworkers); 39 physicians; 202 nurses; 1 18 law enforcement officers: 20 attorneys and judges; 57 psychologists; and 223 other professionals (ministers, educators, voluntary agency personnel, etc.). The sample was 26.2% male, with a mean age of 37 years (SD = 10.5) and a median 7.0 years (M = 9.9) ofprofessional practice. One-fourth (26.4%) of the group was fairly new to their profession, having practiced for two or less years. About half (5 1.1%) of all the respondents and more than a quarter (29%) of those who saw five or more child sexual abuse cases per month reported no previous forma1 training in the evaluation of alleged sexual abuse victims. Apparently some of this formal training was received after the individual began practicing as a professional, since those who had been in practice the least amount of time (O-2 years) reported formal training least often (38.8%). while over half (53.6%) of those who had been in practice for more than two years reported some formal training in the evaluation of child sexual abuse. Previous training was reported significantly more often by social workers (67.4%) and law enforcement officers (65.8%) than other professionals (32.7-49.1%) as shown in Table 2. Significant differences in the number of years in professional practice were also noted by professional group. The medical professionals reported the most years of professional experience on average (18.8 years for medical doctors, 14.5 years for registered nurses); the social workers and the other group reported the least mean number of years of professional experience (7.0 and 6.2. respectively). About half (50.8%) of all the respondents reported seeing 2 or more victims of child sexual abuse per month; 20.5% reported seeing 5 or more child sexual abuse victims per month. Those with 7 or less years of experience saw more victims of child sexual abuse (25.3% saw 5 or more victims per month) as compared with those who had more than 7 years of professional experience (14.9% saw 5 or more victims per month). There was also a significant difference in the number of child sexual abuse cases seen by professional groups. The social workers, law enforcement and psychologists reported seeing more victims than the other professionals, while the medical doctors and nurses saw fewer victims. As also shown in Table 2. significant differences in the overall knowledge questionnaire

Patterns of child sexual abuse knowledge

351

scores were seen for the professional groups. The Duncan’s range test (Walpole, 1982) on the data showed the total test scores for the social workers were significantly higher than all of the other professional groups except the psychologists, while the psychologists and the physicians scored significantly higher than the attorneys and the law enforcement professionals. The percent of professionals who answered correctly to the items on the questionnaire is summarized in Table 1. The respondents were generally knowledgeable about child sexual abuse; however, there were several items where more than 20% of the professionals indicated an incorrect response. The majority (52.2%) ofthe professionals did not indicate that children who are sexually abused may have positive feelings about the experience at the time. More than a third (34.6%) of the professionals believed that most fathers who sexually abuse their daughters are likely to abuse other children or rape adult women. A significant percentage (28.4%) of the professionals incorrectly thought most sexual abuse of children involves physical force. About a fourth of the respondents incorrectly indicated that most sexual abuse of children includes intercourse (25.1%) and were unaware that many runaway children and adolescents have been sexually abused before running away (25%) or that a sexually abused child may have a normal physical examination (25.8%). Over a fifth (2 1.5%) of the professionals believed that professionals who report a case of suspected child abuse can be sued if the case is not substantiated in court. For the three professional groups consisting of at least 100 respondents (nurses, law enforcement professionals, and social workers), the responses to the questions reflected their professional training to some degree. For example, the nurses more often knew that a sexually abused child may have a normal physical examination, and the law enforcement professionals more often knew that professionals who report a case of suspected child abuse cannot be sued if the case is not substantiated in court. The social workers appeared to be the most knowledgeable of these three groups. Table 3 indicates those professionals who reported having some formal training in child sexual abuse tended to score better on the questionnaire than those without formal training. Although those with training responded correctly more often to 13 of the 14 items, the difference was statistically significant for only 7 of the 14 items. On all of the items, those who reported seeing five or more child sexual abuse victims per month responded more correctly than those who saw fewer victims per month. The difference, however, was statistically significant for only two items. Also, those having two or fewer years of professional practice generally scored more incorrect responses to the questions, although the difference was significant on only two items. The correlation coefficient between age of the professional and total test score showed a weak negative relationship. The female professionals responded more correctly than the males to three of the items (p < .05); however, this finding may be more a function of the differences by professional group since there was a strong relationship between gender and professional group.

DISCUSSION The evaluation of alleged child sexual abuse victims requires the efforts and expertise of many professionals. Clinical experience with misperceptions of the physician’s role and medical evaluation has led to this examination of professionals’ knowledge and perceptions of child sexual abuse. Less than half of the responding professionals attending the educational program had previous training in child sexual abuse, despite a median of seven years of practice in their respective professions. While disconcerting, this is consistent with other reports (Chang et al., 1976; Hibbard et al., 1987). Even those who saw several victims per month had not all had formal training in child sexual abuse. However, having formal training in this field did not necessarily

352

Roberta

A. Hibbard

Table 3. Percent Responding Correctly

Most sexual abuse of children involves physical force. (False) Children who have been sexually abused usually tell someone soon after the abuse. (False) Professionals who report a case of suspected child sexual abuse can be sued ifthe case is not substantiated in court. (False) Most fathers who sexually abuse their daughters are likely to abuse other children or rape adult women. (False) Children who are sexually abused may have positive feelings about the experience at the time. (True) In most cases, children who are sexually abused are abused by strangers. (False) Most adults who sexually abuse children were abused in some way as children. (True) Most sexual abuse of children includes intercourse. (False) The Child Protective Services investigates only reports of child sexual abuse made by professionals. (False) A professional must have physical evidence of child sexual abuse before repporting the cast to Child Protective Services. (False) Many runaway children and adolescents have been sexually abused before running away. (True) Children who may have been sexually abused do not need medical examinations if the abuse occurred more than 72 hours before the child told someone. (False) A sexually abused child may have a normal physical examination. (True) Sexually transmitted diseases (venereal warts, gonorrhea, herpes) in children usually come from sources other than sexual contact. (False) * Adjusted

chi-square

comparing

Those with Previous Training N=442 (p value)*

Those Seeing Five or More Victims per Month N= 151 (p value)*

71.6

75.7 (0.0091)

80.9 (0.0059)

69.

88.5

86.7 (0.167 I)

89.3 (0.9442)

92.2 (0.0816)

78.5

82.5 (0.0052)

83.7(0.1814)

78. I (0.7788)

65.4

7 I .O (O.OOQS)

68.8 (0.4455)

64.1 (0.7 134)

47.8

52.6 (0.0068)

56.0 (0.0 198)

37.0 (0.0014)

95.9

97.4 (0.0526)

96.5(1.0000)

94.3(0.1819)

87.5

88.0 (0.2345)

90.7 (0.2583)

83.9 (0. I 149)

94.9

75.9 (0.5943)

80.8 (0.1528)

70.2 (0.0743)

93.3

94.9 (0.08 12)

96.4 (0.2 124)

89.1 (0.0072)

88.3

92.4 (0.0003)

94.2 (0.0654)

88.0 (0.5439)

75.0

78.2 (0.0335)

80.4 (0.1134)

67.9 (0.0297)

86.8

89.4 (0.0359)

90.5 (0.2257)

87.4

74.2

76.9 (0.0708)

75.9 (0.6138)

68.5 (0.0489)

85.4

89.9 (0.0003)

89. I (0.3335)

83.2 (0.25 I 1)

Total Group N=902

Statement

responses

and Terre11 W. Zollinger

as to the Accuracy of the Sexual Abuse Knowledge Statements

ofthose

in this category

Two or Fewer Years in Practice N= 191 ( p value) l

I (0.3888)

( I .OOOO)

with those not in this category.

lead to more correct responses to the items in this questionnaire. In general, more social workers and law enforcement officers reported previous training, while social workers and psychologists scored the highest on the test instrument. Relatively few physicians or attorneys reported training. Of greatest concern was the knowledge of those who saw the greatest number of child sexual abuse cases. As noted, those who saw five or more victims per month did score higher on this test, but the differences were not consistently significant. Obviously, all who see child sexual abuse victims should be highly knowledgeable about the field, but those who see the greatest

Patterns ofchild sexual abuse knowledge

353

of victims riced to be the most knowledgeable because their actions and decisions will affect the greatest number of children. Professionals were generally knowledgeable about child sexual abuse issues; however al least 20% of the professionals were not knowledgeable about some items that are important in identification of sexual abuse. For example, many professionals did not know that children who are sexually abused may have positive feelings at the time, that many runaway children and adolescents have been sexually abused before running away, or that a sexually abused child may have a normal physical exam. In addition, at least 20% of the professionals had misperceptions that might hamper the legal and medical investigation of the case, such as believing most sexual abuse of children involves physical force, that most children have abnormal physical examinations, that most sexual abuse of children includes intercourse, and that profmsionals who report a case of suspected child sexual abuse can be held legally liable if the case if not substantiated in court. Previous training in the field of child sexual abuse was only somewhat helpful in enabling the professionals to more correctly respond to the items on the questionnaire. This finding suggests the education they received regarding these medical and legal issues was inadequate or ineffective. This is more apparent for the training received as part of the professionals’ academic or pre-service training, because those with two or less years of professional experience were less knowledgeable than rhose who had been working for more than two years. Apparently there is a need to increase the child sexual abuse component af the training for these professionals. Some may question the interpretation of Item 3: “Professionals who report a case of suspected child sexual abuse can ix sued if the case is not substantiated in court” as being a false statement. The intent of the statement was “Professionals. . -cannot be ~~cc~~~~~~~ sued. . .” When this issue was raised during the administration of the questionnaire, it was clarified as such. However, one can recognize that some respondents may have answered the question with the understanding that professionals can be sued, but not successfully. At the time the questionnaires were administered, Item 4, “Most fathers who sexually abuse their daughters are likely to abuse other children or rape adult women,” was considered false by most experts. However, recent reports (Abel, Becker, & CunRin~am-Rathner, 1984; Abel, Becker, Cunningham-Rather, Mittelman, & Rouleau, 1988; Abel, Becker, Murphy, & Flanagan, 198 1) indicate incestuous fathers often have other sexually deviant behavior. It is possible some respondents were familiar with these reports and more “up to date” on this issue at the time of the questionnaire. Relatively fewer physicians and attorneys attended these training programs. Members of these professions play a role in iden~f~ng and providing care for victims of child abuse and neglect and need to be informed; earlier studies of physicians have indicated they recognize a need for further training (Attias & Goodwin, 1985; Rosonke & Pelton, 1982; Winefield & Castell-McGregor, 1986). Poor attendance of lawyers and physicians may reflect a lack of willingness of these professionals to devote an entire day to such training programs when time away from their private practices may equate to a substantial loss in potential income. Saulsbury and Campbell ( 1985) documented the unwillingness of physicians to report or become involved in child abuse issues because of fears of disrupting family-physicians relationships, reluctance to be involved in the court system, and frustration with the system. Child abuse evaluations require considerable time and are poorly reimbursed, adding barriers discouraging private practitioners from getting invoived. These data also suggest a need for continued education of all profizssionals involved_ Both medical and non-medical professionals must become more knowledgeable of the current understanding of issues related to child sexual abuse if children are to receive adequate and most appropriate care. This understanding needs to expand beyond the normal professional training received. A broader understanding will not only help the professionals provide better Rum&r

354

Roberta A. Hibbard and Terre11W. allinger

care to the children, but will be useful in improving communication and coordination of efforts between the professions. Further research in the area of perceptions and practices is necessary to address important issues regarding the most effective educational format to train professionals on how to appropriately evaluate alleged child sexual abuse victims. Acknowledgement-The authors thank Mary Von Burg for assistancein program development, data collection, and manuscript preparation; and Jean Strand and Georgia Hartman for assistance in data management.

REFERENCES Abel, G. G., Becker, J. V., & Cunningham-Rathner, J. (1984). Complications, consent, and cognitions in sex between children and adults. International Journal of Law and Psychiatry, 7,89- 103. Abel, G. G., Becker, J. V., Cunningham-Rathner, J., Mittelman, M., SCRouleau, J. L. (1988). Multiple paraphilic diagnoses among sex offenders. Bulletin of the American Academy of Psychiatry and the Law, 16, 153-168. Abel, G. G., Becker, J. V., Murphy, W. D., & Flanagan, B. (198 I). Identifying dangerous child molesters. In R. B. Stewart (Ed.), Violent behavior: Social learning approaches to prediction, management, and treatment (pp. 1 I6137). New York: Brunner/Mazel. Attias, R., & Goodwin, J. (1985). Knowledge and management strategies in incest cases: A survey of physicians, psychologists, and family counselors. Child Abuse & Neglect, 9, 527-533. B&ton, H. L. (1984). Do physicians recognize sexual abuse? American Journal of Diseases of Children, 141, 402403. Chang, A., Oglesby, A. C., Wallace, H. M., Goldstein, H., & Hexter, A. C. (1976). Child abuse and neglect: Physicians’ knowledge, attitudes, and experiences. American Journal of Public Health, 66, 1 l99- I20 I. Eisenberg, N., Owens, R. G., & Dewey, M. E. (1987). Attitudes of health professionals to child sexual abuse and incest. ChildAbuse& Neglect, 11, 109-l 16. Finkelhor, D. ( 1984). Child sexual abuse: New theory and research. London: Collier Macmillan. Hazzard, A. ( 1984). Training teachers to identify and intervene with abused children. Journal of Clinical Child Psychology, 13,288-293. Hazzard, R. A., & Rupp, G. (1986). A note on the knowledge and attitudes of the professional groups toward child abuse. Journal of Community Psychology, 14,2 19-223. Hibbard. R. A., Serwint, J., & Connolly, M. (1987). Educational program on evaluation of alleged sexual abuse victims. Child Abuse & Neglect, 11,5 13-5 19. Ladson. S.. Johnson. C. F.. JL Dotv. R. E. I 1987). Do phvsicians recoanize sexual abuse? American Journal ofDiseases ofchtldren, 141,411-415. .’ ’ . _ Lena, H. F., & Warkov, S. ( 1978). Occupational perceptions of the causes and consequences of child abuse/neglect. Medical Anthropology, 2, I-23. Morris, J. L., Johnson, C. F., & Clasen, M. (1985). To report or not to report: Physicians’ attitudes toward discipline and child abuse. American Journal of Diseases of Children, 139, l94- 197. Orr, D. P. (1978). Limitations of emergency room evaluations of sexually abused children. American Journal of Diseases of Children, 132,873-875. Orr, D. P., & Prietto, S. V. ( 1979). Emergency management ofsexually abused children. American JournalofDiseases of Children, 133,628-63 I. Rosonke, J. R., & Pelton, C. L. (1982). Community and professional perceptions of child abuse and neglect. Journal of Medicine of South Dakota, pp. 7- 12. Saulsbury, T., KcCampbell, R. E. (1985). Evaluation of child abuse reporting by physicians. American Journal of Diseases of Children, 139,393-395. Walpole, R. E. ( 1982). Introduction to statistics. London: Collier Macmillan. Willis, S. E., & Homer, R. D. (1987). Attitudes experience, and knowledge of family physicians regarding child sexual abuse. The Journal of Family Practice, 25,5 16-5 19. Winefield, H. R., & Castell-McGregor, S. N. (I 986). Experiences and views of general practitioners concerning sexually abused children. The Medical Journal ofAustralia, 145,3 1 I-3 13. Woolf, A., Taylor, L., Melnicoe, L., Andolesk, K., Dubowitz, H., DeVos, E., & Newberger, E. (I 988). What residents know about child abuse: Implications of a survey of knowledge and attitudes. American Journal of Diseases of Children, 142,668-672.

Resume-Atin de mieux apprehender les connaissances et les perceptions que des professionnels de la same ont au sujet des s&ices sexuels i I’&gardd’enfants, les auteurs ont me& une enqugte parmi 902 professionnels participant a des cours sur le sujet pendant fan&e 1986-1987. Le 50.896, soit i peu p&s la moitie du groupe ont affirm& devoir s’occuper chaque mois d’au moins deux enfants victimes de &ices sexuels; le 20.5% ont affirmi en avoir 5 ou plus. La moitii i peu p&s, soit le 48.9% des participants ont dit qu’ils avaient recu un enseignement formel dans le domaine des abus sexuels i l’&gard d’enfants. Ces personnes etaient en g&r&al bien inform&es sur le sujet, cependant le 20%

Patterns of child sexual abuse knowledge

355

d’entre eux ne connaissaient pas grand chose au sujet de certains points qui itaient t&s importants lorsqu’il s’agit d’identifier un cas de &ices sexuels chez I’enfant et cette miconnaissance peut inte&rer avec la gestion l&gale et midicale du cas. Les personnes ayant recu une formation formelle et ayant a leur actif un certain nombre d’annies de pratique professionnelle, et qui en plus voient 5 ou d’avantage de victimes par mois ont repondu le plus correctement, mais les differences n’itaient pas toujours statistiquement significatives. La conclusion est qu’il faut pousser la formation i la fois des medecins et des professions paramedicales afin que la prise en charge des enfants victimes de &ices sexuels soit plus appropriee et que les communications et la coordination des efforts entre les differentes professions soient meilleures. Resumen-Para comprender mejor el conocimiento y las percepciones acerca del abuso sexual del menor, se Ilevi, a cabo una encuesta con 902 profesionales atendiendo programas de education acerca del abuso sexual de menores durante 10saiios 1986- 1987. Aproximadamente la mitad (50.8%) del grupo inform6 ver por lo menos dos cases al mes de abuso sexual del menor, mientras que 20.5% informaron ver o m&s. Casi la mitad (48.9%) de 10sque respondieron informaron tener entrenamiento formal previo en el campo del abuso sexual del niiio. Los profesionales estaban generalmente bien informados acerca del abuso sexual del niiio, pero por lo menos 20% de 10s profesionales no estaban bien informados acerca de algunos puntos que son importantes en la identification del abuso sexual del niiio y que podrian poner trabas a la investigation medica y legal del case. Los profesionales con entrenamiento formal, mis aiios de prictica profesional, y que ven cinco o mh victimas al mes contestaron ma preguntas correctamente, pero las diferencias no fueron siempre estadisticamente signiftcantes. Mh entrenamiento para tanto profesionales medicos coma no medicos es necesario para asegurar el tratamiento apropiado de las victimas del abuso sexual del menor y para mejorar la comunicacion y la coordination entre profesionales.

Patterns of child sexual abuse knowledge among professionals.

To better understand knowledge and perceptions of child sexual abuse, a survey was conducted of 902 professionals attending child sexual abuse educati...
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