Arts and Social Sciences, Irving K. Barber Faculty of (Okanagan)
Psychology, Department of (Okanagan)
DSpace
UBCO
Biener, Cassidy
Doctor of Philosophy - PhD
University of British Columbia
Child abuse is a severely underreported crime (7 – 15%; General Social Survey, 2019; Winters et al., 2020). Reporting is crucial to seeking and obtaining formal support for those impacted. Before a report can be made, the abuse must be discovered through the presence of evidence or disclosure. Study 1 focused on exploring differences in disclosure and related factors between child sexual abuse (CSA) and child physical abuse (CPA). Study 2 investigated the responses of prominent disclosure recipients. Through the analysis of n = 466 RCMP files, Study 1 revealed significant differences in CSA and CPA along disclosure-relevant dimensions (e.g., child’s age, gender, severity and frequency of abuse, and relation to perpetrator (p < .001)). Disclosures were more crucial to the discovery of CSA but were delayed longer than CPA. Non-offending caregivers were the largest group of disclosure recipients. Study 2 utilized a subset of data from Study 1 n = 258, those where non-offending caregivers were aware of the abuse and able to respond. The MDS configurations were different across abuse types. Non-offending caregivers generally responded to disclosures with support. However, only 54% of caregivers reported it. Abuse type was a significant predictor of support, with more blame and less interruption of contact between the perpetrator and child in cases of CPA. Further, being related was a significant predictor of reporting CSA, while frequency of abuse predicted reporting of CPA. Overall, these studies contribute to a deeper understanding of the complexities involved in disclosing and responding to disclosures of abuse.
“You can tell me anything”: The role of caregivers in obtaining and maintaining support for children after receiving a disclosure of physical or sexual abuse by Cassidy Biener M.A., The University of British Columbia Okanagan, 2019 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY in THE COLLEGE OF GRADUATE STUDIES (Psychology) THE UNIVERSITY OF BRITISH COLUMBIA (Okanagan) December 2023 © Cassidy Biener 2023 ii The following individuals certify that they have read and recommend to the College of Graduate Studies for acceptance, a dissertation entitled: An examination of child single and multitype maltreatment and their comparative versus combined impact on disclosure: Moving towards a more comprehensive theory of disclosure across abuse types submitted by Cassidy Biener in partial fulfillment of the requirements of the degree of Doctor of Philosophy . Dr. Michael Woodworth, Irving K. Barber Faculty of Arts and Social Sciences Supervisor Dr. Brian O’Connor, Irving K. Barber Faculty of Arts and Social Sciences Supervisory Committee Member Dr. Jamie Piercy, Irving K. Barber Faculty of Arts and Social Sciences Supervisory Committee Member Dr. Judy Gillespie, Faculty of Health & Social Development University Examiner Dr. Kamala London, University of Toledo External Examiner iii ABSTRACT Child abuse is a severely underreported crime (7 – 15%; General Social Survey, 2019; Winters et al., 2020). Reporting is crucial to seeking and obtaining formal support for those impacted. Before a report can be made, the abuse must be discovered through the presence of evidence or disclosure. Study 1 focused on exploring differences in disclosure and related factors between child sexual abuse (CSA) and child physical abuse (CPA). Study 2 investigated the responses of prominent disclosure recipients. Through the analysis of n = 466 RCMP files, Study 1 revealed significant differences in CSA and CPA along disclosure-relevant dimensions (e.g., child’s age, gender, severity and frequency of abuse, and relation to perpetrator (p < .001)). Disclosures were more crucial to the discovery of CSA but were delayed longer than CPA. Non-offending caregivers were the largest group of disclosure recipients. Study 2 utilized a subset of data from Study 1 n = 258, those where non-offending caregivers were aware of the abuse and able to respond. The MDS configurations were different across abuse types. Non-offending caregivers generally responded to disclosures with support. However, only 54% of caregivers reported it. Abuse type was a significant predictor of support, with more blame and less interruption of contact between the perpetrator and child in cases of CPA. Further, being related was a significant predictor of reporting CSA, while frequency of abuse predicted reporting of CPA. Overall, these studies contribute to a deeper understanding of the complexities involved in disclosing and responding to disclosures of abuse. iv LAY SUMMARY Child abuse is notoriously underreported, largely because the decision to disclose is typically complex for those experiencing it. Many factors have been linked to delays or non-disclosure of child sexual abuse, but few studies have examined child physical abuse. Study 1 compared disclosures of child sexual and physical abuse through the examination of child and abuse characteristics. Disclosure of these two forms of abuse was found to be substantially different. For example, disclosure delays were longer in sexual abuse but were more required for reports. Study 2 explored the responses of non-offending caregivers to disclosures of abuse (i.e., with blame, belief, interruption of contact, and reporting the abuse) and factors that may inhibit support. Non-offending caregivers were more supportive after receiving a disclosure of sexual abuse compared to physical abuse. Our findings add to a greater understanding of factors that can either inhibit or encourage support after receiving a disclosure. v ACKNOWLEDGEMENTS The completion of my dissertation would not have been possible with out the unwavering support and supervision of Dr. Michael Woodworth. I would like to express my deepest appreciation to my other committee members Dr. Brian O’Connor, and Dr. Jamie Piercy for their continued encouragement and advice throughout my PhD. I would also like to thank the Child Advocacy Centre of Kelowna and the Kelowna RCMP for their partnerships which made this research possible. Specifically, from the Child Advocacy Centre, Ginny Becker and Sarah Armstrong, and from the RCMP Lynn Doran, Constable McCarthy, and Inspector Moss. As well as every MDT member along the way. Special thanks to Zak Draper and Rebecca Goddard for their statistical support. vi DEDICATION As someone who started this journey as a single mother, I want to dedicate this to all the young women out there who are struggling to find their worth. I couldn’t have done this without the support of my wonderful family and friends, and I hope other young women can find the people that will lift them up. vii TABLE OF CONTENTS ABSTRACT .................................................................................................................................. iii LAY SUMMARY ......................................................................................................................... iv ACKNOWLEDGEMENTS ......................................................................................................... v DEDICATION ............................................................................................................................. vi LIST OF TABLES ....................................................................................................................... xi LIST OF FIGURES .................................................................................................................... xii CHAPTER 1: INTRODUCTION ................................................................................................ 1 CHAPTER 2: STUDY 1 – A COMPARATIVE ANALYSIS OF DISCLOSURE ACROSS ABUSE TYPE................................................................................................................................ 4 2.1 Antecedents of Disclosure ........................................................................................................... 5 2.2 Theories of Disclosure ................................................................................................................. 7 2.3 Child Sexual Abuse ................................................................................................................... 13 2.3.2 Gender ................................................................................................................................ 16 2.3.3 Severity and Frequency ...................................................................................................... 18 2.3.4 Relation ............................................................................................................................... 19 2.4 Child Physical Abuse ................................................................................................................ 21 2.4.1 Age ...................................................................................................................................... 22 2.4.2 Gender ................................................................................................................................ 23 2.4.3 Severity and Frequency ...................................................................................................... 23 2.4.4 Relation ............................................................................................................................... 24 2.5 Comparing Child and Abuse Characteristics Across Abuse Types ..................................... 25 2.6 Comparing CSA and CPA Disclosures ................................................................................... 26 2.7 The Current Study .................................................................................................................... 29 2.7.1 Hypotheses .......................................................................................................................... 29 CHAPTER 3: STUDY 1 METHOD .......................................................................................... 31 3.1 Participants ................................................................................................................................ 31 3.1.1 Demographic Characteristics of Data ............................................................................... 31 3.2 Measures .................................................................................................................................... 32 3.2.1 Help-seeking Characteristics ............................................................................................. 32 3.2.2 Child Characteristics .......................................................................................................... 32 3.2.3 Abuse Characteristics......................................................................................................... 32 3.3 Procedure ................................................................................................................................... 33 3.4 Planned Analysis ....................................................................................................................... 34 viii 3.4.1 Descriptive statistics ........................................................................................................... 34 3.4.2 Group Differences .............................................................................................................. 34 CHAPTER 4: STUDY 1 RESULTS .......................................................................................... 36 4.1 Descriptive Statistics ................................................................................................................. 36 4.1.1 CSA ..................................................................................................................................... 36 4.1.2 CPA ..................................................................................................................................... 37 4.2 Mann-Whitney U Tests ............................................................................................................. 39 4.2.1 Abuse Type and Age ........................................................................................................... 39 4.2.2 Abuse Type and Severity .................................................................................................... 39 4.2.3 Abuse Type and Frequency ............................................................................................... 39 4.2.4 Abuse Type and Relation ................................................................................................... 40 4.2.5 Abuse Type and Delays of Disclosure ............................................................................... 40 4.3 Test of two proportions............................................................................................................. 41 4.3.1 Abuse Type and Gender ..................................................................................................... 41 4.3.2 Abuse Type and Prior Disclosure ...................................................................................... 41 CHAPTER 5: STUDY 1 DISCUSSION .................................................................................... 42 5.1 Child Characteristics ................................................................................................................ 42 5.1.1 Age ...................................................................................................................................... 42 5.1.2 Gender ................................................................................................................................ 43 5.2 Abuse Characteristics ............................................................................................................... 43 5.2.1 Severity and Frequency of Abuse ...................................................................................... 43 5.2.2 Relation to perpetrator ....................................................................................................... 45 5.3 Application of Disclosure Theory to CSA and CPA .............................................................. 46 5.4 Disclosure ................................................................................................................................... 47 5.4.1 Delays of Disclosure ........................................................................................................... 48 5.4.2 Prior Disclosure ................................................................................................................. 48 5.4.3 Disclosure Recipients ......................................................................................................... 49 5.5 Conclusion ................................................................................................................................. 50 CHAPTER 6: STUDY 2 – NON-OFFENDING CAREGIVER RESPONSES TO DISCLOSURES OF ABUSE ..................................................................................................... 51 6.1 Vicarious Trauma ..................................................................................................................... 52 6.2 Making Sense of the Disclosure ............................................................................................... 53 6.3 Responding to Disclosures ........................................................................................................ 53 6.4 Theories of Reporting ............................................................................................................... 54 6.5 Predictors of Disclosure Responses ......................................................................................... 60 ix 6.5.1 Age ...................................................................................................................................... 60 6.5.2 Gender ................................................................................................................................ 61 6.5.3 Severity & Frequency ......................................................................................................... 61 6.5.4 Relation ............................................................................................................................... 62 6.6 Multidimensional Scaling Analysis .......................................................................................... 63 6.7 Current Study ............................................................................................................................ 63 6.7.1 Hypotheses .......................................................................................................................... 64 CHAPTER 7: STUDY 2 METHOD .......................................................................................... 66 7.1 Participants ................................................................................................................................ 66 7.2 Measures ................................................................................................................................ 66 7.2.1 Child and Abuse Characteristics ....................................................................................... 66 7.2.2 Non-offending Caregiver Responses ................................................................................. 67 7.3 Procedure ................................................................................................................................... 68 7.4 Planned Analysis ....................................................................................................................... 69 7.4.1 Descriptive Statistics........................................................................................................... 69 7.4.2 Multidimensional Scaling Analysis ................................................................................... 69 7.4.3 Test of Two Proportions ..................................................................................................... 69 7.4.4 Logistic Regressions ........................................................................................................... 70 CHAPTER 8: STUDY 2 RESULTS .......................................................................................... 71 8.1 Descriptive Statistics ................................................................................................................. 71 8.1.1 Non-offending Caregiver Responses to Sexual Abuse Disclosures ................................. 71 8.1.2 Non-offending Caregiver Responses to Physical Abuse Disclosures ............................... 71 8.2 Multidimensional Scaling Analysis .......................................................................................... 72 8.2.1 Multidimensional Scaling Analysis with Abuse Type as a Variable ................................ 72 8.2.2 Multidimensional Scaling Analysis on CSA ..................................................................... 73 8.2.3 Multidimensional Scaling Analysis on CPA ..................................................................... 75 8.3 Test of Two Proportions ........................................................................................................... 75 8.3.1 Belief ................................................................................................................................... 75 8.3.2 Blame .................................................................................................................................. 76 8.3.3 Interrupting Contact .......................................................................................................... 76 8.3.4 Reporting ............................................................................................................................ 77 8.4 Logistic Regression ................................................................................................................... 77 8.4.1 Believing CSA .................................................................................................................... 77 8.4.2 Believing CPA .................................................................................................................... 78 x 8.4.3 Blaming in CSA ................................................................................................................. 78 8.4.4 Blaming in CPA ................................................................................................................. 79 8.4.5 Interrupting Contact in CSA ............................................................................................. 79 8.4.6 Interrupting Contact in CPA ............................................................................................. 79 8.4.7 Reporting in CSA ............................................................................................................... 79 8.4.8 Reporting in CPA ............................................................................................................... 80 CHAPTER 9: STUDY 2 DISCUSSION .................................................................................... 82 9.1 Multidimensional Scaling Analysis – Examining Patterns of Child and Abuse Characteristics, and Non-offending Caregiver Responses ................................................................ 82 9.1.1 Abuse as Variable ............................................................................................................... 83 9.1.2 MDS on CSA ...................................................................................................................... 85 9.1.3 MDS on CPA ...................................................................................................................... 86 9.2 Supportive Behaviours ............................................................................................................. 89 9.2.1 Believing the Child ............................................................................................................. 89 9.2.2 Blaming the Child .............................................................................................................. 91 9.2.3 Interrupting Contact .......................................................................................................... 92 9.2.4 Reporting ............................................................................................................................ 92 9.3 Conclusion ................................................................................................................................. 94 CHAPTER 10: CONCLUSION ................................................................................................ 95 10.1 Implications ............................................................................................................................... 95 10.2 Limitations and Future Directions .......................................................................................... 99 10.3 Conclusion ............................................................................................................................... 102 TABLES ..................................................................................................................................... 105 FIGURES ................................................................................................................................... 115 REFERENCES .......................................................................................................................... 121 APPENDICES ........................................................................................................................... 148 Appendix A – General Coding Form ................................................................................................ 148 Appendix B – CSA Coding Form ...................................................................................................... 151 Appendix C – CPA Coding Form ...................................................................................................... 153 Appendix D – MDS R Code ............................................................................................................... 156 xi LIST OF TABLES Table 1. ................................................................................................................................................. 105 CSA and CPA behaviours recorded. ..................................................................................................... 105 Table 2. ................................................................................................................................................. 106 Frequency of relation to perpetrator. ................................................................................................... 106 Table 4. ................................................................................................................................................. 108 Prevalence of Non-offending Caregiver Responses. ............................................................................. 108 Table 5. ................................................................................................................................................. 109 Spearman's rho correlation matrix for all variables of interest. .......................................................... 109 Table 6. ................................................................................................................................................. 110 Spearman’s rho correlation matrix for CSA variables and non-offending caregiver responses. ......... 110 Table 7. ................................................................................................................................................. 111 Spearman’s rho correlation matrix for CPA variables and non-offending caregiver responses. ........ 111 Table 8. ................................................................................................................................................. 112 Logistic Regression Predicting the Likelihood of a Non-offending Caregivers Believing the Child a Disclosure of CSA. ................................................................................................................................ 112 Table 9. ................................................................................................................................................. 113 Logistic Regression Predicting the Likelihood of a Non-offending Caregivers Reporting the Abuse after a Disclosure of CSA. ............................................................................................................................. 113 Table 10. ............................................................................................................................................... 114 Logistic Regression Predicting the Likelihood of a Non-offending Caregivers Reporting the Abuse after a Disclosure of CPA.……………………………………………………………………………………………………………….………114 xii LIST OF FIGURES Figure 1. ............................................................................................................................................... 115 Shepards Plots displaying the fit of the possible Multidimensional Scaling Models. ........................... 115 Figure 2. ............................................................................................................................................... 116 Multidimensional Scaling Model of Child and Abuse Characteristics, and Non-offending Caregiver Responses .............................................................................................................................................. 116 Figure 3. ............................................................................................................................................... 117 Multidimensional Scaling Model of Child and Abuse Characteristics, and Non-offending Caregiver Responses for CSA ................................................................................................................................ 117 Figure 4. ............................................................................................................................................... 118 Multidimensional Scaling Model of Child and Abuse Characteristics, and Non-offending Caregiver Responses for CPA ................................................................................................................................ 118 Figure 5. ............................................................................................................................................... 119 Receiver Operating Characteristic Curve displaying the Impact of Child and Abuse Characteristics on Reporting CSA ...................................................................................................................................... 119 Figure 6. ............................................................................................................................................... 120 Receiver Operating Characteristic Curve displaying the Impact of Child and Abuse Characteristics on Reporting CPA ...................................................................................................................................... 120 1 CHAPTER 1: INTRODUCTION Childhood abuse is a prominent issue worldwide, with self-report studies indicating that 12.7% have experienced childhood sexual abuse (CSA), and 22.6% have experienced childhood physical abuse (CPA) before the age 16 (Stoltenborgh et al., 2015). Thirty-two percent of Canadians have reported experiencing at least one form of childhood maltreatment (Afifi, 2014). The overall annual economic cost of childhood maltreatment in Canada has been estimated to be $22.4 billion in 2017 (Bowlus et al., 2003; Shaffer et al., 2018). Yet, the financial outlay does not begin to approximate childhood maltreatment's social and emotional impact. The province of British Columbia has been reported to have the second-highest rate of childhood maltreatment nationally (35.8%; Afifi et al., 2014). Despite high rates of occurrence, only a small number of those impacted report ever seeking formal support (e.g., reporting to police, child protection agencies, or mental health professionals), with rates of reporting as low as 7% - 15% (Canada General Social Survey, 2019; Bottoms et al., 2016; Lev-Wiesel & First, 2018; London et al., 2005; Winters et al., 2020). These statistics demonstrate that child abuse is a severely under-reported crime (Winters et al., 2020). Reporting is a crucial step in seeking and obtaining formal support for children and families impacted by childhood maltreatment. Research is needed to examine low rates of reporting childhood abuse more thoroughly. The overarching goal of the current set of studies is to examine the process of disclosure and reporting across abuse types (i.e., CSA and CPA). It is estimated that only 10-15% of CSA cases (Bottoms et al., 2016; Lev-Wiesel & First, 2018; London et al., 2005) and 7-9% of CPA cases (Bottoms et al., 2016; Bottoms et al., 2007) ever make it to the formal investigation stage. Reports of abuse are often delayed, with averages between the initial incident of sexual abuse and reports of three years (Wallis & Woodworth, 2 2020). This lack of or even a delay in reporting can result in a myriad of negative consequences for the child. First, reporting is an important help-seeking function. It is only after a report is made that criminal justice outcomes can potentially occur, and psychological support can be accessed. However, if a report is delayed or never made, the symptoms of poor mental health and posttraumatic stress can become greater over time (Nemeroff, 2016; O’Leary et al., 2010; Ullman, 2007). Secondly, any delay in an investigation risks the loss of valuable evidence and consequently, perpetrators are unlikely to be held responsible (McElvaney et al., 2014; Thackeray et al., 2011). Third, an arguably even greater consequence of the lack of reporting is that youth may be continually put in danger’s way (Olafson & Lederman, 2006). In fact, experiencing either physical or sexual abuse has been found to be associated with a higher rate of subsequent revictimization (Canada General Social Survey, 2019). For example, children who have experienced sexual abuse reported sexual assault and physical assaults in adulthood at three times the rate of those who have not experienced sexual abuse. This is an even stronger finding for women (Canada General Social Survey, 2019). Alternatively, when child abuse is reported in a timely manner, children tend to develop less adverse psychological symptoms and problem behaviours later on (Broman-Fulks et al., 2007; Townsend, 2016; Ullman, 2007). Further, proper disclosure of abuse has been shown to potentially have an adaptive value for victims in that it can help them understand the abuse, manage their feelings surrounding the abuse, and develop trust and hope for the future and in others (Isely, 1992; Lamb & Edgar‐Smith, 1994; Park & Blumberg, 2002; Pipe et al., 2007). Reporting is of the utmost importance as it opens up the possibility of obtaining support for the child and holding perpetrators accountable. However, the decision to report is often complex and influenced by various factors (Bachman, 1993; Copes et al., 2001; Gartner & 3 MacMillan, 1995; Skogan, 1984). Both the child and the recipient of the disclosure often go through a decision-making process that leads to either reporting and seeking help or choosing not to report. Survivors of childhood abuse have highlighted numerous challenges associated with reporting. Winters and colleagues (2020) interviewed 76 undergraduate women who reported an experience of CSA to facilitate an enhanced understanding of why some may hesitate or choose not to report formally. The study revealed several key themes, including negative perceptions of the victim and the reporting process itself, emotional distress, safety concerns, negative consequences of disclosure and abuse, and fear of not being believed or supported. While many pitfalls were noted, so were a number of benefits to reporting. Reporting can bring about feelings of safety, prevent future abuse, hold perpetrators accountable and provide them with necessary help, facilitate emotional processing and coping, offer support and treatment to the affected child, raise awareness, and reduce stigma for potential future victims who may also choose to report (Winters et al., 2020). The participants strongly recommended that individuals who have experienced sexual abuse should report it. However, it is worth noting that 50% of victims disclosed the abuse informally, while only 10% made a formal report (Winters et al., 2020). The two current related studies aim to delve deeper into the subsequent steps of the help-seeking process, namely disclosure and reporting. Study 1 will explore potential differences in disclosure and disclosure-related factors across different types of abuse (i.e., CSA and CPA). Study 2 will then examine the responses of prominent disclosure recipients, with a specific focus on how they may respond with supportive or unsupportive reactions to these disclosures. 4 CHAPTER 2: STUDY 1 – A COMPARATIVE ANALYSIS OF DISCLOSURE ACROSS ABUSE TYPE Substantiation of some forms of abuse is highly dependent on disclosure unless other evidence is available (e.g., medical evidence in cases of CSA; Dubowitz et al., 1992). Some forms of abuse also leave behind more evidence, such as injury in the case of physical abuse. Unfortunately, even in the presence of evidence of abuse, 33% of children have been found to fail to disclose or deny allegations within forensic interviews (Elliot & Briere, 1994; Lyon et al., 2020). Forensic interviews are information gathering sessions conducted by trained professionals on victims, witnesses and suspects that seek to understand what did and did not happen. Despite this, disclosure itself can still have benefits, even if it does not progress to the formal investigation stage. Disclosures are crucial for the child experiencing abuse as they can help to ease the psychological burden, often manifesting as posttraumatic symptoms. According to the inhibition model, efforts to constrain thoughts, feelings, or behaviours can be physiologically stressful (Pennebaker, 1989). When stress is added through inhibition, this will place greater demands on the victim and may exacerbate psychosomatic processes, resulting in more significant symptomology. Disclosure then may serve as a mechanism for lessening the psychosocial demand on the body, resulting in more positive prognoses (Pennebaker, 1989). The incidence of post-traumatic stress disorder (PTSD) diagnosis in those who have experienced abuse may be as high as 13% (Copeland et al., 2007). Studies have attempted to discern the relationship between disclosure and posttraumatic stress symptomology by comparing cases in which different lengths of time passed before a disclosure was made (Ruggiero et al., 2004; Sinclair & Gold, 1997). An association between long delays and increased posttraumatic stress symptoms was found 5 (Ruggiero et al., 2004). Further, disclosure has also been linked to lower levels of externalizing behaviour (e.g., acting out), especially when those children received support (Gries et al., 2000). As a result of the combination of negative consequences for non-disclosure and positive outcomes following disclosure, it is imperative to better understand its antecedents in cases of childhood maltreatment. 2.1 Antecedents of Disclosure When abuse is experienced in childhood, it may occur before the child develops an understanding of socially accepted norms. In a qualitative meta-analysis, Brennan and McElvaney (2020) explored antecedents to disclosure in childhood and adolescence and identified two overarching themes. The first theme, referred to as the need to tell, encompasses intrapersonal factors such as realization, emotional distress, and the need for action. Realization occurs gradually as children develop language skills and an understanding of what constitutes abuse. Emotional distress, which children may struggle to cope with, can also prompt disclosure. Additionally, the need for something to be done to protect themselves and potentially other children serves as a motivating factor for disclosure. The second theme was the opportunity to tell, which comprised interpersonal factors. Opportunity to tell was highly dependent on having access to someone the child can trust and on expecting to be believed. In this meta-analysis, having a trusted individual to tell was the most highly rated factor impacting the decision to disclose (Brennan & McElvaney, 2020). Trusted individuals included family, peers, schoolteachers, and sports coaches. These individuals may then make a formal report of abuse on behalf of the child, facilitating access to support and inhibiting future abuse. However, perpetrators of sexual abuse commonly have a pre-existing relationship with the child (e.g., 92%; Wallis & Woodworth, 2020), which in some cases may 6 leave the child without a trusted adult to tell. If individuals who have experienced sexual abuse do have a trusted adult to report to, they may still face challenges regarding belief and validation. Some parents have reported responding to a disclosure of sexual abuse with shock and disbelief, even if they claim to believe the child (McElvaney et al., 2014). It has been proposed that initial disbelief may be a form of protective denial in which parents may shield themselves from guilt or blame that they might feel for letting the abuse occur (Summit, 1993). Wallis and Woodworth (2021) found that 14% of caregivers demonstrated general disbelief after their child disclosed. Denial and disbelieving reactions are understandably perceived to be unsupportive by victims (Bolen & Lamb, 2008). The need to tell and opportunity to tell converge when individuals are asked about their experiences. Prompted disclosure has been found to be significant, with over 40% of children only disclosing after being asked (Hershkowitz et al., 2007). One study asked 13- and 14-year old's if they had ever experienced a serious problem, they had never told anyone about (Fuller et al., 2001). Most youth in this study revealed secrets related to puberty, sex, illegal activity, addictions, smoking and drinking, physical abuse, and sexual abuse. This resulted in some youths reporting sexual abuse for the first time. However, those impacted often state that there is never a right time to discuss the abuse and that they are never asked about it (Jensen et al., 2005). Alternatively, caregivers often state that they are too embarrassed or just do not know how to broach this subject with their child (Wallis & Woodworth, 2021). This hesitancy among caregivers to ask children directly is echoed in other studies, where caregivers express fear of causing further harm to the child or disrupting family relationships and emphasize the importance of being “absolutely sure” before approaching the child (Jensen et al., 2005). 7 The above themes illustrate what McElvaney and colleagues (2012) termed the 'pressure cooker effect.’ Wherein a child's internal conflict and eventual decision to disclose is dependent on both internal and external pressure. Despite the positive outcomes associated with disclosure, as mentioned earlier, few children make it to this stage, and different forms of abuse present unique challenges that individuals must overcome before they can disclose. While the need and opportunity to tell (as well as being asked by someone) precede a disclosure, they do not explain the process of that disclosure. Various theories can help facilitate our understanding of how disclosures unfold. 2.2 Theories of Disclosure In an attempt to understand and explain the experiences of children making disclosures, multiple theories have been proposed. There are several theoretical frameworks to draw from when considering disclosures of abuse, specifically sexual abuse. The dynamics of CSA proposed by Sgoi and colleagues (1982) follow a typical five-phase pattern: the engagement phase; the sexual interaction phase, the secrecy phase, the disclosure phase; and a suppression phase following a disclosure. Of particular focus in the current study are the final three stages of the dynamics of CSA. After the child experiences CSA, they will often enter the secrecy phase, which may be imposed by the perpetrator (Burgess & Holmstrom, 1975). Secrecy can be kept through the use of threats or feelings of shame in the child (Sgoi et al., 1982). In the disclosure phase, there are two types of CSA disclosure: accidental disclosures and purposeful ones. Accidental disclosures can occur in two ways when an external circumstance sheds light on the abuse. Alternatively, the child may unknowingly disclose. Accidental disclosure is typically due to developmental limitations surrounding the child’s understanding of the abuse. Purposeful disclosure occurs when the child intends to report the abuse to seek support and inhibition of 8 future abuse. Finally, in the suppression phase that follows a disclosure, the family will attempt to hide the abuse and inhibit intervention. Sgoi and colleagues (1982) proposed that the progression of abuse reflects that there is often a delayed response between abuse and disclosure. Summit (1983) attempted to incorporate the idea of delayed disclosures as well as unconvincing and retracted disclosures in ‘Child Sexual Abuse Accommodation Syndrome’ (CSAAS). They proposed five categories of CSAAS. (1) Secrecy, similar to those dynamics explored by Sgoi and colleagues (1982), involves the construction of the abuse by the perpetrator as something to be feared and kept secret. (2) Helplessness occurs when children who have experienced abuse feel they cannot stand up for themselves or do anything to stop the abuse. (3) Entrapment and accommodation occur if the child does not report the abuse. When not reported, abuse can quickly become a repetitive pattern until the child achieves autonomy or discovery of the abuse occurs (Herman, 1981). (4) Delayed, Conflicted, and Unconvincing Disclosure may occur when abuse comes forward due to family conflict, discovery by a third party, or further education by outreach organizations. In these cases, it may not have been the child’s intention to come forward. When family conflict brings forth a disclosure, this may lead some to rationalize that the report is in reaction to punishment and, therefore, false, in which case children can seem angry and unreliable within interviews. When abuse is discovered through alternative means and the child has not decided to come forward this may taint their disclosure. (5) Retraction is the fifth and final stage. Once a disclosure has occurred, the aftermath will often determine whether the prior disclosure is retracted. The aftermath can include consequences to the family and child for their disclosure, negative reactions of caregivers, and/or the child may be brought in for forensic interviews. Being brought into the police station for a forensic interview can be confusing for children and they may mistakenly believe that they are in trouble (Summit, 1983). 9 The final stages of the CSAAS model demonstrate the difficulty of disclosure, even once it is already given. It also acknowledges the impact of outsider responses on further or future disclosures. The dynamic process of CSA and the ‘CSAAS’ theories share several similarities. Similarities between these models include the significant impact that secrecy has upon initial disclosure, an ensuing disclosure, and then (depending on how the disclosure is received), a suppression or retraction phase. While CSAAS-consistent explanations for nondisclosure are present when examined independently and tested using large samples, they do not seem to be able to predict who will and who will not disclose abuse (London et al., 2008). Similarly, the social exchange theory applies principles of cost and reward to CSAAS (Leonard, 1996). In the social exchange theory, disclosure patterns such as secrecy, helplessness, entrapment, delayed disclosure, and recantation are the most profitable options available to victims as they allow the maintenance of relationships with the perpetrator, who may be a close relative, and inhibit consequences to the family. There are several limitations to the above-mentioned theories which include a lack of scientific basis and inability to test these theories (Lyon et al., 2020). These theories discussed above are focused on the entire experience of abuse but still do little to address how disclosures are made. First, it is important to note that CSA cases in which a disclosure is made are the exception rather than the norm (Collings, 2006; Muller, 2003; Stoltenborgh et al., 2011). In the majority of cases, disclosures may never be made or may not be made until well into adulthood (Easton, 2013). Avoidant responses such as non-disclosure, denial, and recantation have been conceptualized as symptoms of PTSD (Koverola & Foy, 1994). Developmental differences in children’s coping resources have also been theorized to shape the context in which abuse occurs 10 and the variability in abuse effects (Cole & Putnam, 1992). For example, coping is limited in the preschool years, so children often rely on denial and dissociative strategies exerted on them through an authoritative relationship with the perpetrator. In addition, school-aged children are more vulnerable to feelings of guilt and shame because of their increased introspective abilities while adolescents often cope with abuse through denial or impulsive behaviours (e.g., substance abuse, sexual behaviours, or running away; Cole & Putnam, 1992). Once children do begin to disclose, these attempts are often made slowly. The ‘no-maybe-sometimes-yes syndrome’ attempts to better understand how disclosures are made by children (MacFarlane & Krebs, 1986). The ‘no-maybe-sometimes-yes syndrome’ explains that the process of disclosure is slow and children typically disclose a little bit at a time, withholding the worst parts until they see how others react to the information given. In the ‘no-maybe-sometimes-yes syndrome,’ timid disclosures are a form of defense mechanism. If reactions to disclosures are negative, children may internalize them and feel unsupported (Finkelhor & Browne, 1985). Negative reactions also translate into betrayal of trust and stigmatization for children making disclosures. Finkelhor (1988) later developed the traumegenic dynamics model, which proposes that CSA involves 4 types of experiences: (1) CSA itself; (2) feelings of powerlessness or helplessness; (3) stigmatization or negative reactions; and (4) betrayal, manipulation, and failure to protect the child. Each of the categories of the traumegenic dynamics model results in its own set of PTSD symptoms (Finkelhor, 1988). These prior models tended to focus on defining the prototypical victim response and linking that response with symptomology. Yet they do not explain why some children may react very differently to similar experiences. 11 The transactional theory states that development evolves through person-environment interactions (Spaccarelli, 1994). The specific combination of person-environment transactions will then determine the trajectory for healthy or psychopathological outcomes (Sameroff & Fiese, 1990). Environments are not static but are subject to change which may impact coping resources available to the child (Sameroff, 1990). In turn, children’s internal resources will also alter the organization of their environment and the direction of developmental trajectories. The transactional theory follows several tenants (Spaccarelli, 1994). First, victims of CSA experience multiple stressors, including the pattern of child-perpetrator interactions that maintain and constitute abuse and resulting changes in the family environment. Second, the formation of negative cognitive appraisals (e.g., perceptions of damage, self-blame, loss of relationships, and betrayal of trust) and problematic coping strategies (e.g., cognitive avoidance, wishful thinking, and symbolic control) mediate the effects of CSA and other related life events. The development of cognitive appraisals and coping responses are also highly dependant on abuse, environmental, and individual variables. Third, there are bidirectional influences between the child’s cognitive and behavioural responses to abusive acts and the environment. In this bidirectional relationship, a child’s response may further increase negative symptomology, especially when unhealthy coping mechanisms (e.g., social isolation, choosing not to report) are utilized. The transactional model accomplishes what previous models have not, by attempting to explore why some children might react differently to very similar stressors. Mental health outcomes are in response to total abuse stress across three stressful events (i.e., abuse, abuse-related, and disclosure-related events; Spaccarelli, 1994). Abuse components here may include the degree of exposure to abuse (e.g., measured as duration/frequency or seriousness), coercion (e.g., physical force/threats, or inducements), denigrating messages (e.g., 12 secrecy, verbal abuse), and trust violation (e.g., intrafamilial abuse). Abuse-related events are those such as family dysfunction, parental separation, and non-support of disclosure. Finally, disclosure-related events may include insensitive/repeated interviewing, removal from the home, poor adjudication outcomes, and stressful testimony (Spaccarelli, 1994). This theory outlines the impact of abuse characteristics such as severity and frequency of abuse, as well as relation to perpetrator on initial disclosures, which are some of the key variables under consideration in the current set of studies. The transactional theory also outlines the impact of environmental triggers on ensuing disclosures. The current study will consider the supportive or unsupportive environment that disclosure recipients may create post disclosure. Stemming from the transactional model, research has begun to focus on the unique contribution of child and abuse characteristics on resulting symptomology and disclosure of the child affected. Characteristics of victims and abuse can provide motivation for children to make a disclosure or alternatively choose to withhold one. According to the socio-cognitive model of disclosure, children consider the consequences of their disclosure. Perception and understanding of the consequences for disclosure are then influenced by children’s cognitive abilities (i.e., internal factors) and social experience (i.e., external factors; Bussey & Grimbeel, 1995). Both internal and external motivations to disclose may fluctuate with changes in child and abuse characteristics. Two themes emerge across these theories. First, initial disclosures may be difficult for children to give and can be impacted by a multitude of factors. Second, initial reactions of disclosure recipients are key to positive outcomes, such as better mental health prognoses and future help-seeking. Theories can help to provide potential conceptualizations and explanations for how disclosures occur. However, in many cases, they fail to address the unique experiences of 13 victims, with only more modern theories (i.e., the sociocognitive model of disclosure) even addressing individual differences. While most theories provide a more general overview of the process of disclosure, it is also crucial to examine child and abuse characteristics as well, as recent research has found they drastically change disclosures (Hershkowitz et al., 2007; Kogan, 2004; McElvaney, 2014; Paine & Hansen, 2002; Wallis & Woodworth, 2020). Child and abuse characteristics fluctuate from case to case and considering these variables will provide a more complete picture of the unique experiences of children while disclosing. Further, it is also important to consider how these variables may impact the disclosures of children experiencing different forms of abuse. 2.3 Child Sexual Abuse CSA is defined as any activity for which the purpose is the sexual gratification of an adult or an older child before the legal age of consent (Johnson, 2004). Sexual abuse may also involve inappropriate contact of the child or of the perpetrator, exposure of sexual body parts, forced exposure to pornography, or the use of a child for the production of pornography. The complexities surrounding the need and opportunity to disclose CSA are influenced by various additional factors (Brennan & McElvaney, 2020). In my master's research, we focused on child characteristics such as age and gender, which have been shown to substantially impact a child’s ability or willingness to report CSA (Wallis & Woodworth, 2020). Similarly, we also examined abuse characteristics, such as severity and frequency of abuse, and the relation between the child and perpetrator, which affected disclosures and delays of disclosure. These child and abuse characteristics can potentially heighten the need to disclose in the following ways: a younger age at the onset of abuse may affect the child's comprehension of the abuse and their realization that it is wrong; being male, having a familial relationship with the offender, and experiencing more 14 severe or frequent abuse can increase the emotional distress experienced by the child; frequent or severe abuse can significantly intensify the child's sense of needing to take action against the abuse. In terms of the opportunity to disclose, if the perpetrator is closely related to the child, it may negatively impact their ability to confide in a trusted adult or their confidence that they will be believed. The next section will consider how a number of specific variables can impact disclosure. 2.3.1 Age Delays between age at onset of abuse and the forensic interview can substantially impact memory, understanding, and ability to describe the incident(s) of sexual abuse (Brilleslijper-Kater et al., 2004; Lippert et al., 2009). An increased difficulty in disclosing at younger ages could be for several reasons. First, younger children often lack the ability to effectively communicate that abuse has occurred. Wallis and Woodworth (2020) conducted analyses, both including and excluding those aged 0 – 4. Even with these cases removed, age continued to have a substantial impact on delays of disclosure. The stability of age as a significant factor indicates that other variable(s) beyond simply an inability to communicate might impact disclosures. Consequently, another possible reason for longer delays of disclosure could be realization. When abuse begins at a younger age, the child may not label their experience(s) as abusive until a later point in time. Further, the perpetrator is more likely to invoke statements such as "it is a game,” which can confuse the child (Brilleslijper-Kater et al., 2004). It is understandable then, that younger children will disclose accidentally rather than purposefully (Paine & Hansen, 2002). A third possible reason disclosures may be delayed in younger children is the relationship between the perpetrator and the child. Those aged 1 – 6 tend to be perpetrated against more often by intrafamilial perpetrators (67%) versus adolescents aged 15 – 18, who are offended against more by extrafamilial perpetrators (80%; Wallis & Woodworth, 2020). One explanation for these 15 findings is that intrafamilial perpetrators would have consistent access to young children who, in turn, have little contact with those outside of the family. In addition, when the perpetrator is more closely related to the child, this breach of trust may normalize abusive behaviour. A final reason is that younger children would have less contact with other trusted adults to whom they could report (e.g., teachers, coaches). Large-scale research has found that schools account for the most significant proportion of reports made by public institutions (Sedlak & Broadhurst, 1996). As a result of the amount of contact with students, teachers may notice behavioural or physical evidence that abuse has taken place and have a duty to report it (Hunt & Broadley, 2020). Due to the greater ability of older children and adolescents to understand abuse, they are more likely to recognize it sooner and report it to a trusted adult. Earlier recognition also means children are not subjected to continued abuse by adults. Some critical caveats for older children and adolescents are that a greater understanding of the abuse may also lead to greater shame or fear of the consequences of their disclosure. Consequences can include having a child removed from the home or possible divorce of parents (Crisma et al., 2004). Adolescents have also reported fears about what others will think if they learn about the experienced abuse. For instance, research has found that older children may be perceived as more at fault for the abuse (Theimer & Hansen, 2017). Likewise, adolescents often report feeling responsible for the abuse (Goodman-Brown et al., 2003). Adolescents may also demonstrate loyalty by protecting perpetrators. By adolescence the abuse may have been ongoing for a substantial period of time, leaving space for extensive grooming practices to be implemented by perpetrators. Adolescents may also experience other pressures that will impact their decision to disclose, such as gender norms. 16 2.3.2 Gender A worldwide meta-analysis of 331 samples with nearly 10,000,000 participants found that 18% of girls experience CSA compared to 7.6% of boys (Stoltenborgh et al., 2011). As a result of the apparent disparity in rates by gender, until recently, research has utilized primarily female samples. More troubling is that symptomology experienced by boys may be comparable to, if not more severe than, what is experienced by girls, perhaps due to greater feelings of shame or stigmatization (Garnefski & Arends, 1998; Ullman & Filipas, 2005). For example, boys who have experienced sexual abuse are significantly more likely to demonstrate problematic behaviour, such as aggressive and criminal acts, drug and alcohol use, truancy, and suicide attempts (Garnefski & Arends, 1998). As such, this group of victims warrants additional attention by research. Indeed, many of the above theories have failed to address gender differences in the process of disclosure (London et al., 2008). However, males may experience different barriers to disclosure than girls. Unique male barriers may result in greater unwillingness to disclose sexual abuse rather than actual differences in rates of CSA experienced (Sorsoli et al., 2008). Sorsoli and colleagues (2008) noted that men who had experienced sexual abuse in childhood made fewer disclosures and had more barriers. In fact, three themes have been identified as exclusive to the inhibition of male disclosure of CSA. Male-specific myths of disclosure include fear of being labelled gay, fear of being stigmatized or isolated due to their victimized status, and fear of continuing the cycle of abuse themselves (Priebe & Göran, 2008; Sivagurunathan et al., 2019; Sorsoli et al., 2008). First, males are often offended against by other males, which can bring into question their masculinity (Alaggia, 2005; Gagnier & Collin-Vézina, 2016; Priebe & Göran, 2008; Sorsoli et al., 2008). Second, due to traditional views of 17 masculinity, there may be greater stigmatization of sexual abuse experienced by males (Priebe & Göran, 2008; Sivagurunathan et al., 2019). Third, greater stigmatization of male-experienced sexual abuse can result in heightened emotional distress for male victims. Fears of stigmatization may be especially prominent when the child or adolescent experienced a contact offence. Finally, there is a fear that men will perpetuate the cycle of abuse against their own children (Priebe & Göran, 2008), despite various studies demonstrating that the majority of parents are able to break the cycle of intergenerational violence (Kaufman & Zigler, 1987; Salter et al., 2003). Greater endorsement of these myths has been associated with increased shame and embarrassment, further impeding nondisclosure for men. (Priebe & Göran, 2008; Sivagurunathan et al., 2019). Another way of classifying male-specific barriers to disclosure is in several experiential domains, including personal, relational, and sociocultural areas (Sorsoli et al., 2008). Obstacles in the personal realm included a lack of awareness, purposeful avoidance, difficulty discussing the topic, either how to bring it up or identifying emotions/thoughts involved, emotional readiness, and shame. Relational barriers were fears of the repercussions of disclosure, isolation, and ideas about relationships. Finally, sociocultural barriers to disclosure are related to the acceptability of male victimization and the pressure not to discuss such experiences (Sorsoli et al., 2008). The impact of barriers on men in these domains may increase in intensity if the abuse is severe or frequent. Women, on the other hand, express different barriers to disclosure. For example, women report being more concerned that their disclosure would negatively impact others and do not want to ‘burden’ them (Goodman-Brown et al., 2003). Women also report greater fears of not being believed, while men report greater confidence in being believed (Goodman-Brown et al., 2003; Allagia, 2004). 18 2.3.3 Severity and Frequency The severity and frequency of abuse have been found to impact rates and delays of disclosure (Bottoms et al., 2016; Hershkowitz et al., 2007; Kogan, 2004; Wallis & Woodworth, 2020). However, the direction in which severity impacts delays of disclosure is contested. On the one hand, it has been found that more severe abuse may be reported immediately because of a need to do something (Kogan, 2004; Leclerc & Wortley, 2015). In this case, disclosure may be inevitable due to the overt signs of abuse, such as STIs, pregnancy, or overt psychological symptoms such as severe self-harm or suicidal ideation. Overt signs of abuse may either motivate the child to come forward or prompt questioning by an adult. Alternatively, children who have experienced more severe abuse may delay their disclosure (Priebe & Göran, 2008). In this case, more severe abuse may compound feelings of shame experienced by children and fears of the negative repercussions and reactions to their disclosure (Lemaigre et al., 2017). A previous study by Wallis and Woodworth (2020) found that more severe or frequent abuse resulted in longer delays of disclosure. Threats are a common component of CSA and can serve to keep children in the secrecy stage of disclosure according to the CSAAS theory discussed above (Summit, 1983). Threats may be utilized to ensure the child complies with the abuse or maintains secrecy (London et al., 2008) and can be centered on fears the child may already hold and serve to further instill them, such as “nobody will believe you,” or they can be violent in nature. They may be directed at the child or others for example, “your family will be hurt” or “I will abuse your sibling if you attempt to tell” (London et al., 2008; Wallis & Woodworth, 2020). Findings regarding the impact of the use of threats on disclosure are conflicting. Some studies have found the use of threats to lead to increased disclosure delays (Ussher & Dewberry, 1995), while others have found the 19 opposite (Hanson et al., 1999; Kellogg & Hoffman, 1995). At the very least, threats can create a sense of helplessness for some victims (Easton et al., 2013). Frequent abuse may be a consequence of delayed disclosures. If the abuse goes unreported, the perpetrator may have consistent access and opportunity to offend against the child. Children with a history of maltreatment have also been found to perceive ambiguous situations as more hostile and may be hypersensitive to negative emotions (Dodge et al., 1995; Pollak et al., 2000). When abuse is ongoing, abused children may become less protective of intrafamilial perpetrators and less trusting of safe adults to whom they may disclose (Malloy et al., 2014). More severe abuse or abuse that has been ongoing may lead to emotional distress and the need to do something, resulting in disclosure. This need to do something may outweigh the possible consequences to their family if they disclose (Kogan, 2004; McElvaney et al., 2014). Severe and frequent abuse has been found to most commonly be carried out by intrafamilial abusers or those with a prior trusting relationship (Bergh, 2017; Ullman, 2007). 2.3.4 Relation Intrafamilial abusers have earlier and more consistent access to children who they might abuse (Bergh, 2017). Intrafamilial perpetrators' position of trust for both the child and caregivers can result in confusion regarding the abuse for the child and lack of believability for the caregiver should the child disclose to them. According to the Betrayal Trauma Theory (BTT), a close relationship between the perpetrator and victim would constitute a betrayal of trust (Foynes et al., 2009). The extent of this betrayal of trust will determine a victim's awareness and memory of traumatic events (Freyd, 1996; Schultz et al., 2002). Children who are abused by close relatives (especially caregivers), may decrease their awareness of the abuse, which allows them to maintain their attachment to the perpetrator. Alternatively, if victims maintain awareness of 20 the abuse, their relationship with the perpetrator is at risk, leading to withdrawal from them or confrontation for abusive behaviour (Foynes et al., 2009). If children respond with withdrawal or confrontation, the perpetrator may in turn decrease positive caregiver behaviours and increase abusive interactions. The BTT framework posits that disclosure poses a risk to the child’s emotional needs (Foynes et al., 2009). The CSAAS theory, which explores potential causes of nondisclosure as identified earlier, was initially designed to address intrafamilial abuse (Summit, 1983). According to CSAAS, delays of disclosure and nondisclosure are heavily reliant on feelings of guilt, loyalty to the abuser, fear of not being believed, and fear of the possible consequences to the family (Bolen & Lamb, 2008; London et al., 2008; Summit, 1983). Previous studies have found that the perpetrator is a family member in nearly one-third of CSA cases (Stoltenborgh et al., 2011). However, this number may be as high as half of all perpetrators (Wallis & Woodworth, 2020). Age has been found to moderate children’s willingness to disclose against familial perpetrators (Lyon et al., 2010). When maltreated and non-maltreated 4- to 9-year-olds are given vignettes in which the perpetrator was either a parent or a stranger and asked what they should do, 4- to 5-year-olds reported less disclosure against parental abusers than 6- to 9-year-olds. As children grow older, maltreated children showed less protection of parental abusers than non-maltreated children (Lyon et al., 2010). When the abuser is related, the child may experience a higher frequency of abuse before disclosure can occur. For example, research has found that when the abuser was a primary caregiver, 80% of those perpetrators committed more than one incident of abuse, and 60% committed ten or more incidents of abuse (Wallis & Woodworth, 2021). Research has also found that when perpetrators are intrafamilial, children will delay disclosure and only disclose when 21 asked (Hershkowitz et al., 2007; Kogan, 2004; Sjöberg & Lindblad, 2002; Wallis & Woodworth, 2020). Being asked is where the need and opportunity to tell coalescence and create the optimal conditions for disclosure (Brennan & McElvaney, 2020). The above-mentioned child and abuse characteristics have been shown to have a substantial impact on children’s ability and decision to disclose in cases of CSA (Alaggia, 2005; Anderson, 2016; Hershkowitz et al., 2007; Lippert et al., 2009; Wallis & Woodworth, 2020). However, much less is known about how these factors impact disclosures in other forms of abuse. To date, all theoretical models of disclosure and abuse have focused solely on sexual abuse. This creates an opportunity for an expansion of our previous research on CSA (Wallis & Woodworth, 2020; Wallis & Woodworth, 2021) by including CPA. The current study hopes to determine how CSA and CPA may differ along several disclosure-related variables. It aims to determine whether pre-existing theories and findings regarding CSA disclosure can be applied to CPA, or if it is necessary to develop new and unique theories specifically for physical abuse. 2.4 Child Physical Abuse In the past CPA has been conceptualized as being on the extreme end of typical parenting behaviours (Belsky, 1980), although most now believe this is an outdated and misguided way to consider physical abuse. Caregivers may employ physical punishment in response to actual or perceived wrongdoings of the child. While the use of corporal punishment has been decreasing, it is still used widely. In 2019, 49% of children in the U.S. between the ages of 0-9 were subjected to corporal punishment, although this rate decreased to 23% in those aged 10-17 (Finkelhor et al., 2019). Most CPA occurs during the commission of punishment (Kolko & Feiring, 2002). Indeed, in the current study many caregivers reported engaging in physical abuse in response to the child’s ‘bad behaviour’. Physical abuse can occur along a spectrum from what 22 may be considered by some as typical punishment (e.g., spanking, or slapping a child’s hand; Finkelhor et al., 2019) to more severe behaviours (e.g., beating up the child, burning/scalding them, or choking a child; Black et al., 2001). Risk factors for the perpetration of CPA can include adjustment issues such as being emotionally reactive, parenting stress, emotional distress, loneliness, anxiety, depression, lack of support and interpersonal problems for mothers, and often alcohol use for fathers (Black et al., 2001). Fifty-two percent of children who experience CPA have been found to disclose their abuse (Jernbro et al., 2017), demonstrating that almost half do not. Similar to CSA, some child characteristics may indicate that children are at an increased risk for experiencing and not disclosing CPA. However, contrary to CSA, there is a dearth of studies examining disclosure of CPA. 2.4.1 Age Children of a younger age may experience a higher rate of CPA due to greater control by and contact with caregivers. The relationship between age and CPA may be curvilinear, with rates peaking between the ages of 3 - 12 (Wolfner & Gelles, 1993). However, this relationship may only relate to minor CPA rather than more severe forms (Connelly & Straus, 1992; Straus et al., 1998). The relationship between age and CPA may also be moderated by race or family structure, such that children of Black or Hispanic background and older children are at higher risk of abuse if both parents are present (Sedlak, 1997). In research examining CPA disclosures, young age was found to be a predictor of disclosure (Lahtinen et al., 2020). Lahtinen and colleagues (2020) found that children in the sixth grade were more likely to disclose than those in the ninth grade. This contrasts with CSA, in which younger children evidenced longer delays of disclosure (Wallis & Woodworth, 2020). 23 2.4.2 Gender Similar to above, gendered disclosure patterns may not hold for CPA as they do for CSA. Findings regarding gender and CPA have been mixed. Some studies have found boys to experience less CPA (Wolfner & Gelles, 1993), while others have reported higher rates of CPA (MacMillan et al., 1997). Alternatively, some studies have found boys to be at higher risk for minor and severe CPA (Wolfner & Gelles, 1993), while others have found boys to be at lower risk for experiencing minor CPA (Straus, 2000). Even more confounding, some studies have found no gender differences in CPA at all (MacMillan et al., 1997; Sedlak, 1997; Wauchope & Straus, 1990). Even less is known about gender differences in relation to disclosure of CPA. Hence, it is difficult to discern whether boys are impacted by the same gender barriers experienced in CSA. For example, boys may have a difficult time disclosing due to typical stereotypes that males should be strong and impervious to victimization (Lahtinen et al., 2020). Tellingly, Lahtinen and colleagues (2020) found being a girl was predictive of disclosures of CPA. 2.4.3 Severity and Frequency Aligning with CSA, abuse characteristics may also impact disclosures of CPA. The severity and frequency of abuse in cases of CSA have been found to result in greater delays of disclosure and nondisclosure (Priebe & Göran, 2008; Wallis & Woodworth, 2020). These findings have been replicated in studies examining CPA (Lahtinen et al., 2020; Lev-Wiesel et al., 2019). In a population-based study from Israel, Lahtinen and colleagues (2020) found that adolescents with multiple maltreatment exposures displayed greater reluctance to disclose and that previous experiences of abuse decreased the likelihood of disclosing to an adult. Jernbro and colleagues (2017) found that more severe CPA and multitype maltreatment predicted a lack of 24 trust in adults. Adolescents also reported a fear of not being believed. These findings suggest that the lack of trust by children who experience CPA and fear of not being believed may be why they choose not to disclose their abuse. Trust and believability of disclosures have in the past been linked with relation to perpetrators (Foynes et al., 2009; Lev-Wiesel & First, 2018; Wallis & Woodworth, 2021). 2.4.4 Relation The reluctance in making CPA disclosures may be due to several abuse characteristics that vary across abuse types. For example, while CSA may be perpetrated by different intrafamilial individuals with a trusted relationship, CPA is most likely to be perpetrated by primary caregivers, predominantly mothers (93%; Hershkowitz et al., 2005; Lev-Wiesel & First, 2018; Romero-Martinez et al., 2014). When intrafamilials perpetrate abuse, this leaves the child, as discussed earlier, without a trusted adult to tell and without a supportive caregiver. Caregiver support has been found to be a significant factor in children's decision to disclose abuse (Wallis & Woodworth, 2021). To demonstrate the impact of relatedness on disclosure, Foynes and colleagues (2009) found that relationship predicted disclosure delays above and beyond any other variable (e.g., age, gender, and severity of abuse). Children may be more reluctant to disclose even when variables such as relation to the perpetrator are held constant (Lev-Wiesel & First, 2018). While research has found that intrafamilial individuals make up a more significant proportion of perpetrators in cases of physical abuse over sexual abuse, there are other factors that might also impact the decision to disclose above and beyond the trusted relationship between perpetrator and victim. 25 2.5 Comparing Child and Abuse Characteristics Across Abuse Types Age, gender, severity and frequency of abuse, and the relationship to the perpetrator may have distinct or similar effects on disclosure across different types of abuse. Although comparative analyses are lacking, we can examine and evaluate existing literature findings. Regarding age, younger children were found to display longer disclosure delays in cases of CSA (Wallis & Woodworth, 2020), while older children have been found to be more reluctant to disclose cases of CPA (Lahtinen et al., 2020). Furthermore, it is noteworthy that CPA may not elicit the same level of shame or embarrassment that accompanies CSA, particularly among boys. Although girls also report similar emotional responses, boys may encounter gender-specific barriers when disclosing incidents of sexual abuse (Lahtinen et al., 2020). The literature does not sufficiently address gender differences in disclosure across abuse types despite some of the potential implications. For example, if boys disclose CSA less frequently compared to both the overall rates of CSA and cases of CPA, this would demonstrate that there may be specific barriers that only affect male disclosure of CSA. In general, gender plays a role in disclosure, with boys facing unique barriers such as concerns about masculinity and stigmatization in cases of CSA, while girls may fear the negative consequences for others and disbelief (Lahtinen et al., 2020; Sgoi et al., 1982; Wallis & Woodworth, 2020). Previous studies on CSA have indicated that both severe and frequent abuse lead to prolonged delays and a lack of disclosure (Lemaigre et al., 2017; Priebe & Göran, 2008; Wallis & Woodworth, 2020). For CPA, the situation is thought to be more complex, with more severe abuse fostering higher levels of distrust in adults and increasing reluctance to disclose (Jernbro et al., 2017). Alternatively, more severe abuse may also provide additional evidence of the abuse itself (Rush et al., 2014), resulting in a report in the absence of a disclosure. Lastly, the 26 relationship to the perpetrator, particularly when they are closely related, can affect disclosure by undermining trust and normalizing abusive behaviour. Both CSA and CPA may be influenced similarly by the perpetrators relationship, creating an environment where children have limited opportunities to disclose to a trusted adult, as well as facing barriers to disclosure resulting from their established trust with the perpetrator. Clearly a comparative analysis is needed to determine how key variables in the disclosure process might differ across abuse types. 2.6 Comparing CSA and CPA Disclosures Differences in child and abuse characteristics across abuse type may help to explain how and why disclosures have also been found to differ. For example, some researchers report those experiencing CPA are more reluctant to disclose (Ghetti et al., 2002; McGuire & London, 2020; Rush et al., 2014). Hershkowitz and colleagues (2005) found higher rates of disclosure among CSA victims (71%) than for CPA victims (61%). Although higher disclosure rates do not directly indicate higher reporting rates, they may be an initial clue into factors that might impact a report. Higher disclosure rates in CSA may result from the, on average, closer relationship between the perpetrator and child in CPA cases (Hershkowitz et al., 2005). Similarly, if the perpetrator is more closely related, as is typically the case in CPA over CSA, this could create additional difficulties in providing support for the child. Less support from non-offending caregivers suggests there could be a risk of lower rates of reporting, with less interruption of contact. Another main difference between CSA and CPA disclosure is the availability of evidence. Evidence in CSA cases is less common and often relies on corroborative evidence (Rush et al., 2014). Alternatively, physical abuse has on average more types of evidence, including corroborative evidence, physical evidence, eyewitness evidence, and in many cases, 27 even perpetrator confession (Rush et al., 2014). As mentioned earlier, CPA frequently occurs in the context of discipline (Kolko & Feiring, 2002). For instance, 63% of 2 – 4-year-olds are physically punished by their parents (Kolko & Feiring, 2002). In situations where discipline escalates into abusive acts, perpetrators may be more inclined to admit their actions as well as have witnesses to the abuse. In contrast, CSA often takes place in secret, without any witnesses to the crime (Leclerc et al., 2009). When the child has experienced sexual abuse, an initial informal disclosure (i.e., one made to a friend or family member) is often made before a formal report can be filed. An informal disclosure typically triggers a formal report as there is rarely substantial physical evidence of sexual abuse to support the claim (Dubowitz et al., 1992). Conversely, in cases of CPA, there may be physical signs of the abuse or a witness, which can lead to a report in the absence of a prior disclosure. Hence, different disclosure histories can influence the reluctance to make subsequent disclosures (Lyon, 2007; Rush et al., 2014). Due to heightened feelings of shame and fear that have been associated with CSA, children may face greater difficulties when disclosing such incidents to adults (Lahtinen et al., 2020). While approximately 48% of children disclose to a friend, only 26% choose to disclose to an adult, in contrast to disclosures of CPA, where adults are informed in 42% of cases (Lahtinen et al., 2020). Consequently, adults may be more inclined to report the abuse to authorities compared to youth who receive a disclosure. Notably, no significant differences were found when directly comparing sexual abuse disclosures made to parents and adults outside the home (Lahtinen et al., 2020). Adults may be more likely to report on behalf of the child as they should possess the knowledge and understanding necessary to make one. Hence, a higher rate of disclosures made to adults should increase the likelihood of subsequent reports being filed. 28 While many differences across abuse types exist, similarities have also been noted. Some researchers have found that abuse, regardless of type has the potential to be traumatic, and there are common patterns and factors associated with disclosure (Bottoms et al., 2016; Foynes et al., 2009; Lev-Wiesel et al., 2014). For example, the most frequent disclosure recipient across abuse types was a close friend (Bottoms et al., 2016; Manay & Collin-Vezina, 2021). Children may then later disclose to a parent if initial disclosures to peers are received well (Manay & Collin-Vezina, 2021). Likewise, both CPA and CSA victims are more likely to disclose if the abuse was frequent, if they were worried about injury, or if the abuse emotionally upset them (Bottoms et al., 2016). These findings indicate that the severity and frequency of abuse may be highly related to disclosure across abuse types. A final commonality is that nondisclosure most often results from a lack of realization of abusive acts as abusive or a belief that the abuse was not severe enough to report (Lahtinen et al., 2020; McGuire & London, 2020). It appears that this lack of understanding of what constitutes abuse can result from either developmental limitations or definitional issues surrounding abuse. In summary, several differences in disclosure-relevant factors have been noted across abuse types, including the presence of prior evidence and emotional responses to it (i.e., feelings of shame or embarrassment in cases of CSA; Lahtinen et al., 2020; Rush et al., 2014). However, other variables have been found to impact disclosure similarly across abuse types (e.g., severity and frequency of abuse). Considering these limited findings, there is still much left to explore between these two forms of abuse. For instance, it is unclear if some of the more established theories around sexual abuse would apply to physical abuse, or if unique theories are required to best understand disclosure across each type of abuse. Further investigation is also needed to determine if there is support for any currently existing theories or if there is a need to create a 29 new one that considers multiple disclosure-relevant factors. The current study is limited by a convenience sample and does not intend to create new theories per se, but it can help to illuminate which variables are most important to consider and whether those variables are the same across abuse types. 2.7 The Current Study The current study aims to identify in what ways disclosures differ across abuse types. As outlined above, sexual and physical abuse are fundamentally different in terms of motivation and situational factors. As a result of these differences, it is crucial to examine variables that impact disclosures across abuse types. This will be accomplished by first comparing the above reviewed array of critical variables to the disclosure process (e.g., age, gender, severity and frequency of abuse, and relation to the perpetrator; Wallis & Woodworth, 2020) across abuse type. Utilizing these key variables, we will consider if it is possible to apply any pre-existing CSA theories of disclosure to CPA. Next, I intend to identify key differences in disclosure across abuse types, such as length of delays of disclosure, whether a first informal disclosure occurred before a formal report, and who informal disclosure recipients are. The aim is to better facilitate understanding of what barriers might be unique or have a stronger impact on one form of abuse over the other. No study, to my knowledge, has explored child and abuse-specific factors in relation to different forms of abuse. Based on the above consideration of the extant literature on CSA and CPA, Study 1 has the following hypotheses. 2.7.1 Hypotheses 1. It is predicted that there will be key differences between abuse types along the main variables of interest (e.g., age, gender, severity and frequency of abuse, and relation to perpetrator). Specifically, it is predicted that: 30 a. Children who disclose CPA will on average be younger, than those disclosing CSA. b. Physical abuse will have a more even spread of genders reporting abuse than sexual abuse, which will be reported substantially more by girls. c. Children involved in a report of physical abuse will be, on average younger than those reporting sexual abuse. d. Children disclosing CSA will experience a higher severity and frequency of abuse before a report is made. e. Perpetrators will be more closely related in physical abuse cases than sexual abuse, being that discipline is usually carried out by primary caregivers. 2. It is predicted that there will be differences in disclosure features across abuse types. Specifically, it is predicted that: a. Delays in disclosure will be longer in cases of CSA than for CPA. b. A previous informal disclosure will be more likely to occur in cases of CSA than for CPA. c. Across abuse types, the largest group of initial informal disclosure recipients will be peer groups. 31 CHAPTER 3: STUDY 1 METHOD 3.1 Participants Cases of child abuse were drawn from the RCMP database for the greater Okanagan area in British Columbia, Canada. Files were from the years 2007 – 2018 and involved a child or youth victim. The following criminal allegations were pulled: • Assault (causing bodily harm, with a weapon and aggravated assault) (ss. 265-268), and sexual offences against children and youth (ss. 151, 152, 153, 155 and 170-172). Not all of the cases included in this study were resolved judicially, they are alleged cases of child abuse. Cases were not coded if they involved incidents of bullying between peers or if the motivation was robbery. These forms of violence while considered assaults did not fall into the typical abuse scenario due to their different context and motivations. This resulted in a total N = 467 files being coded, n = 284 files involving CSA, and n = 183 files involving CPA. These cases often included details of the victim and offender, the incident which initiated the report, and transcriptions from forensic interviews with victims, witnesses, and suspects. 3.1.1 Demographic Characteristics of Data For children who have experienced abuse, n = 336 were girls and n = 132 were boys. The mean age of children at first incident of abuse was M = 11.48, SD = 4.82. As for ethnicity of the child group, which was reported based on visual confirmation by RCMP officers, the largest group identified was Caucasian with n = 334, n = 41 were Aboriginal/Indigenous, n = 13 were South Asian, n = 4 were Asian, n = 5 were Black, n = 4 were Middle Eastern, n = 9 were Hispanic, and n = 58 were unknown/not reported. For child abuse perpetrators n = 48 were women and n = 418 were men. Mean age of perpetrators was M = 33.32, SD = 14.73, with n = 96 being 18 or under and n = 361 being 19 or 32 older. As for ethnicity of the perpetrator group, which was reported based on visual confirmation by RCMP officers, the largest group identified was Caucasians with n = 353, n = 29 were Aboriginal/Indigenous, n = 15 were East Indian/South Asian, n = 7 were Asian, n = 4 were Black, n = 4 were Middle Eastern, n = 3 were Hispanic, and n = 49 were unknown/not reported. 3.2 Measures 3.2.1 Help-seeking Characteristics Case files were coded and analyzed for specific independent variables and non-offending caregiver responses to disclosures using a researcher created coding form (see in Appendix A). Cases were coded for abuse type (e.g., CSA or CPA), presence of prior disclosure (e.g., yes, no), disclosure recipient, and who made the initial report. 3.2.2 Child Characteristics Child characteristics that were collected were gender of victim (e.g., boy or girl) and perpetrator (e.g., man or woman). In our analyses gender was coded as 1 for girls and 2 for boys. The age of the victim at abuse onset and age of perpetrator at time of first incident were recorded. Finally, ethnicity of the child and perpetrator were recorded. Again, it is important to note that ethnicity was collected based on visual observation by RCMP officers. 3.2.3 Abuse Characteristics A scale was adapted from the Abuse Dimensions Inventory (ADI) to assess abuse characteristics such as severity and frequency of abuse, and relation to perpetrator (Chaffin et al., 1997). This scale was chosen because it provided the most comprehensive list of abusive behaviours. Sexual abuse was measured on a 12-point scale from sexually suggestive talk, hugs, or kissing = 1, visually exposing genitals (abuser or child), voyeurism or viewing pornography = 2,… vaginal or anal intercourse (including unsuccessful attempts) = 10, paraphilic sex = 11, 33 ritual and satanic abuse or sexualized torture = 12; Chaffin et al., 1997). Physical abuse was measured along a 10-point scale from pushing or shaking = 1, excessive disciplinary spanking = 2,… batter, beatings, and other major assaults = 7, attacked with weapon = 8, burned extensively = 9, sadistic injury or torture = 10; Chaffin et al., 1997). Full scales are available in Table 1 and Appendix B and C. In addition, the ADI rated the relationship between the abuser and victim along a continuous scale (intra versus extrafamilial). This factor was looked at along a continuum of degree of closeness to the victim. For example: in-home primary caretaker, noncustodial parent…, teacher…, stranger (Chaffin et al., 1997). 3.3 Procedure The primary researcher was given special permission to access classified RCMP case files from their database. While these files are typically difficult to access, partnerships between the researchers and the Child Advocacy Centre (CAC) of Kelowna have aided in these efforts. The primary researcher underwent a strict security clearance in order to view these case files. Steps were taken to assure the privacy of the files, including coding in a private office at the CAC of Kelowna and having the RCMP officers transport the files to this location on an encrypted password-protected USB. As the files coded were sensitive, steps were also taken to ensure the mental health of the researcher coding. These steps included coding for no more than three hours consecutively once per day and having a counsellor on standby in case of any needed support. Cases were coded for abuse type, gender of victim and perpetrator, age of the victim at abuse onset and age of perpetrator at time of first incident, severity and frequency of abuse, relation to the perpetrator, presence of evidence or prior disclosure, who made the initial report, and non-offending caregiver disclosure. Files were provided to the researcher on a USB and 34 were never housed on the researcher’s computer. All variables were recorded on a researcher-created coding sheet in excel and did not contain any identifiable information. Once the researcher was done coding for the day the USB was removed and locked back up at the CAC of Kelowna. Coding sheets were held on a research-specific laptop that is encrypted and password protected until entered into the data spreadsheet. Once entered the original coding sheet was deleted. With the above steps in mind the current procedure was previously given ethical approval (e.g., H18-00273). 3.4 Planned Analysis 3.4.1 Descriptive statistics First, descriptive statistics were employed to examine rates of occurrence such as demographic characteristics and abuse type. Further, we considered how often girls versus boys disclose abuse, age at initial incidents, severity and frequency of abuse, relation to the perpetrator, and disclosure-related variables such as whether a prior disclosure was made, and whom it was made to. 3.4.2 Group Differences Next, we compared cases of sexual abuse to cases of physical abuse along several child, abuse, and disclosure characteristics. First, a Test of Two Proportions was utilized to test for group differences in the presence of a prior disclosure between CSA and CPA. This test was chosen because of the dichotomous nature of both the dependent and independent variables. Afterwards, Mann-Whitney U Tests were employed to determine whether age, severity, frequency, relation, and delays of disclosure were significantly different across abuse types. That is, to determine if these continuous/ordinal dependent variables differed across categorical abuse types. Upon visual inspection of the distributions of sexual and physical abuse, they did not have the same 35 distributions, meaning our sample did not meet the assumption of homogeneity of variances for a parametric test. A non-parametric analysis was then used as it does not require this assumption. Effect sizes for the Mann Whitney U tests were calculated using the following equation r = Z/√N as recommended by Fields (2013) and Rosenthal (1994). Differences of proportions were calculated for the Tests of Two Proportions. 36 CHAPTER 4: STUDY 1 RESULTS 4.1 Descriptive Statistics 4.1.1 CSA 4.1.1.1 Child Characteristics Of the N = 467 cases coded n = 284 reported experiences of CSA. Two hundred and forty-five were girls, and n = 39 were boys. The average age for this group was M = 11.08, SD = 4.611, with a range of (0, 18). Ethnicity of this group was comprised of n = 195 Caucasian, n = 31 Aboriginal, n = 6 South Asian, n = 4 Hispanic, n = 3 Black, n = 3 Asian, and n = 42 were unknown. These were the noted labels given by RCMP officers in their files and do not reflect current terminology. 4.1.1.2 Perpetrator Characteristics Gender of perpetrators of CSA were n = 4 women, and n = 280 men/boys. The average age for this group was M = 31.22, SD = 15.461 with a range of (9, 88). Seventy-three were 18 or younger, and n = 206 were 19 years or older, n = 5 were unknown. Ethnicity of this group was comprised of n = 204 Caucasian, n = 22 Aboriginal, n = 9 South Asian/East Indian, n = 1 Hispanic, n = 3 Black, n = 6 Asian, and n = 35 were unknown. 4.1.1.3 Abuse Characteristics Sexual abuse was measured on a ten-point scale and had a mean of M = 6.57, SD = 3.165. Of CSA cases n = 115 involved a penetrative act whether successful or not. For a full list of CSA behaviours see Table 1. For number of CSA incidents experienced, n = 141 experienced one incident of CSA, n = 16 experienced two incidents, n = 33 experienced three incidents, n = 25 experienced 4 – 9 incidents, and n = 61 experienced ten or more incidents. In n = 8 cases the frequency of abuse was unknown. One hundred and Seventy-four cases of CSA involved an 37 extrafamilial perpetrator, while n = 105 were intrafamilial perpetrators. Of the intrafamilial perpetrators n = 38 were custodial caregivers and n = 22 were noncustodial parents. For further details regarding relation between child and perpetrator see Table 2. 4.1.1.4 Disclosure In cases of CSA n = 61 (23.7%) of children disclosed within a few days of the initial incident. The average delay in disclosure was M = 1443.83 days, the median was Mdn = 130, the mode was m = 1, and the standard deviation was SD = 4696.5. As for prior disclosures, n = 215 disclosed prior to a report, while n = 62 did not. In n = 7 it was unclear who a disclosure was made to, but transcripts stated it did occur. Ninety-four (33.1%) of non-offending caregivers were disclosure recipients. Non-offending caregivers were the largest group of disclosure recipients. For a full list of disclosure recipients see Table 3. 4.1.2 CPA 4.1.2.1 Child Characteristics Of the N = 467 cases coded n = 183 reported experiences of CPA. Ninety cases were girls and n = 93 cases were boys. The average age for this group was M = 12.07, SD = 5.071 with a range of (0, 18). Ethnicity of this group was comprised of n = 138 Caucasian, n = 10 Aboriginal/Indigenous, n = 7 South Asian, n = 5 Hispanic, n = 4 Middle Eastern, n = 2 Black, n = 1 Asian, and n = 16 were unknown. 4.1.2.2 Perpetrator Characteristics Gender of perpetrators of CPA were n = 43 women, n = 139 men/boys, and n = 1 unidentified. The average age for this group was M = 36.64, SD = 12.836 with a range of (10, 73). Twenty-two were 18 or younger, n = 155 were 19 years or older, and n = 6 were unknown. Ethnicity of this group was comprised of n = 148 Caucasian, n = 7 Aboriginal/Indigenous, n = 6 38 South Asian, n = 4 Middle Eastern, n = 2 Hispanic, n = 1 Black, n = 1 Asian, and n = 14 were unknown. 4.1.2.3 Abuse Characteristics Physical abuse was measured on a 10-point scale and had a mean of M = 3.77, SD 1.88. For a full list of CPA behaviours see Table 1. For number of CPA incidents experienced, n = 111 experienced 1 incident of CPA, n = 9 experienced 2 incidents, n = 7 experienced 3 incidents, n = 16 experienced 4 – 9 incidents, and n = 14 experienced 10 or more incidents. In n = 26 cases the frequency of abuse was unknown. Seventeen cases of CPA involved an extrafamilial perpetrator, while n = 160 were intrafamilial perpetrators. Of the intrafamilial perpetrators n = 99 were custodial caregivers and n = 27 were noncustodial parents. For further details regarding relation between child and perpetrator see Table 2. 4.1.2.4 Disclosure In cases of CPA n = 81 (66.9%) children disclosed within a few days of the initial incident. The average delay in disclosure was M = 392.79 days, the median was Mdn = 1, the mode was m = 1, and the standard deviation was SD = 1068.104. In cases of CPA n = 74 disclosed prior to a report, while n = 118 did not. In n = 2 cases it was unclear who the disclosure recipient was, but it was stated that a disclosure occurred. Thirty-eight non-offending caregivers were disclosure recipients. In cases of CPA an additional, n = 21 non-offending caregivers found out about the abuse through other means (e.g., witness to the abuse or injury of the abuse). Again, non-offending caregivers were the largest group of disclosure recipients. For a full list of disclosure recipients see Table 3. 39 4.2 Mann-Whitney U Tests 4.2.1 Abuse Type and Age A Mann-Whitney U test was run to determine if there were differences in ages of victims between sexual and physical abuse. Distributions of age for sexual and physical abuse were not similar, as assessed by visual inspection, as such mean ranks were used. Ages of victims for sexual abuse (mean rank = 218.32) were statistically significantly lower than for physical abuse victims (mean rank = 256.04), U = 29871.500, z = 2.958, p = .003. When considering a correction for Type 1 errors of .05/7 = .007, this would still be significant. The effect size for the difference between groups was r = 0.14 which is considered a small effect size (Field, 2013). 4.2.2 Abuse Type and Severity First severity of abuse scores of CSA and CPA were standardized in order to be comparable. A Mann-Whitney U test was then run to determine if there were differences in severity of abuse between sexual and physical abuse. Distributions of severity for sexual and physical abuse were not similar, as assessed by visual inspection, as such mean ranks were used. Severity of sexual abuse (mean rank = 261.84) was statistically significantly higher than for physical abuse victims (mean rank = 185.52), U = 17107.50, z = -6.043, p < .001. When considering a correction for Type 1 errors of .05/7 = .007, this would still be significant. The effect size for the difference between groups was r = 0.28 which is approaching a medium effect size (Field, 2013). 4.2.3 Abuse Type and Frequency A Mann-Whitney U test was run to determine if there were differences in frequency of abuse between sexual and physical abuse. Distributions of frequency for sexual and physical abuse were not similar, as assessed by visual inspection, as such mean ranks were used. 40 Frequency of sexual abuse (mean rank = 233.70) was statistically significantly higher than for physical abuse victims (mean rank = 187.65), U = 17058, z = -4.126, p < .001. When considering a correction for Type 1 errors of .05/7 = .007, this would still be significant. The effect size for the difference between groups was r = 0.20 which is considered a small effect size (Field, 2013). 4.2.4 Abuse Type and Relation A Mann-Whitney U test was run to determine if there were differences in relation to perpetrator between sexual and physical abuse. Distributions of relation for sexual and physical abuse were not similar, as assessed by visual inspection, as such mean ranks were used. Relation to perpetrator for sexual abuse (mean rank = 179.88) was statistically significantly lower than for physical abuse victims (mean rank = 314.78), U = 10719.500, z = -10.816, p < .001. When considering a correction for Type 1 errors of .05/7 = .007, this would still be significant. The effect size for the difference between groups was r = 0.50 which is considered a large effect size (Field, 2013). 4.2.5 Abuse Type and Delays of Disclosure A Mann-Whitney U test was run to determine if there were differences in delays of disclosure between sexual and physical abuse. Distributions of delays for sexual and physical abuse were not similar, as assessed by visual inspection, as such mean ranks were used. Delays of disclosure for sexual abuse (mean rank = 218.63) were statistically significantly longer than for physical abuse victims (mean rank = 127.63), U = 8062, z = -7.749, p < .001. When considering a correction for Type 1 errors of .05/7 = .007, this would still be significant. The effect size for the difference between groups was r = 0.40 which is considered a medium effect size (Field, 2013). 41 4.3 Test of two proportions 4.3.1 Abuse Type and Gender A test of two proportions was used to examine differences across abuse type, a dichotomous variable, along another dichotomous variable, victim gender. Our cases met the sufficient sample size of > 5, with a minimum expected count of 51.6. The test of two proportions used was the chi-square test of homogeneity. Four hundred and sixty-six children who have experienced abuse were split into those experiencing CSA (n = 284) and CPA (n = 182). Of the 284 CSA cases, 245 were girls (86.3%), while the remaining 39 were boys (13.7%). Of the 182 CPA cases, 89 were girls (48.9%), while the remaining 93 were boys (51.1%). The difference in proportions was .374, p < .001. When considering a correction for Type 1 errors of .05/7 = .007, this would still be significant. 4.3.2 Abuse Type and Prior Disclosure A test of two proportions was used to examine differences across abuse type, a dichotomous variable (e.g., CSA, CPA), along another dichotomous variable, presence of prior disclosure (e.g., yes, no). Our cases met the sufficient sample size of > than 5, with the minimum expect count of 72.17. Four Hundred and sixty-five children who have experienced abuse were split into those experiencing CSA (n = 283) and CPA (n = 181). Of these cases 64 children who had experienced CSA (22.6%) had not made a prior disclosure, while 219 (77.4%) had. Of children experiencing CPA, 121 (66.9%) did not make a prior disclosure, while 60 (33.1%) had. The difference in proportions was .443, p < .001. When considering a correction for Type 1 errors of .05/7 = .007, this would still be significant. 42 CHAPTER 5: STUDY 1 DISCUSSION Child sexual abuse and physical abuse were found to be fundamentally different along several disclosure relevant dimensions including age of child disclosing, gender, severity and frequency of abuse, and relation to perpetrator. Further, disclosure itself, was found to be fundamentally different across abuse types with one similarity. The largest group of disclosure recipients were found to be non-offending caregivers across both CSA and CPA. These results are invaluable to our greater understanding of disclosure across abuse type. 5.1 Child Characteristics 5.1.1 Age It was hypothesized that children who disclose CPA would, on average, be younger than those disclosing CSA. Children who experience CSA have been found to delay disclosures longer than children who experience CPA (Wallis & Woodworth, 2020). Alternatively, older children who experience CPA have, in the past, been found to be more reluctant to disclose (Lahtinen et al., 2020). This reluctance has been theorized to result from more awareness of the consequences of disclosure as children age (London et al., 2005). Despite past theories and findings, this prediction was not supported in the current sample. Children who disclosed CSA were, on average, significantly younger than those disclosing CPA, by one year (11 and 12, respectively). In cases of CSA, disclosure is more often required for a report to be made. As a result of the greater need for disclosure to bring a report forward, children disclosing CSA may be younger. At the same time, especially in younger children, the evidence of CPA might prompt adults to act without disclosure. Younger children who experience CPA are not ultimately required to disclose as much as those who experience CSA. In other words, young children experiencing CSA must disclose to obtain support, but CPA may be detected in other ways. 43 5.1.2 Gender In response to the unique barriers that boys and men face when deciding to disclose experienced sexual abuse (Sorsoli et al., 2008), it was predicted that they would disclose CSA less often than girls and would disclose CPA at comparable rates. Predictions regarding gender distributions were supported, as boys accounted for 14% of disclosures of CSA and 51% of disclosures for CPA. Recent research on self-reported rates of CSA victimization in Canada revealed that women were three times more likely to experience sexual abuse before the age of 15 than men (Heidinger, 2022). So, while it was predicted that boys would report CSA at a lower rate than girls, the proportion of boys reporting was not expected to be so low. One explanation for this disparity in reporting could be the presence of male-specific barriers to disclosure in cases of CSA. These male-specific barriers include the fear of being labeled gay, being stigmatized, or continuing the abuse themselves (Sorsoli et al., 2008). Additionally, these findings suggest that CPA may not carry the same level of shame and stigma associated with CSA experiences for males (Lahtinen et al., 2020). The gender distribution of individuals reaching the formal disclosure stage in cases of CPA aligns with self-reported proportions, demonstrating an even spread of gender (Heidinger, 2022). 5.2 Abuse Characteristics 5.2.1 Severity and Frequency of Abuse Abuse characteristics were found to impact disclosures in various ways with key differences across abuse types. It was hypothesized that children disclosing CSA would encounter a higher severity and frequency of abuse prior to making a report and this was supported. Children disclosing CSA did indeed experienced higher abuse severity before a report 44 was made, as well as more frequent incidents of abuse prior to a report, than those disclosing CPA. 5.2.1.1 Severity As hypothesized, children experiencing CSA reported a higher severity of abuse than children experiencing CPA. Within the context of abuse severity, definitional barriers to disclosure have consistently been noted in the literature for both CSA and CPA. Definitional barriers refer to an individual's inability to recognize and acknowledge an incident as abusive (Finkelhor et al., 2003). In the case of CSA, unless the abuse is of such extreme severity that it cannot be misconstrued, it may not be disclosed. Similarly, more severe cases of physical abuse are more likely to prompt immediate disclosure or a report. Physical abuse often leads to more significant injuries and tangible evidence of the crime (Rush et al., 2014), which increases the likelihood of a report without the need for explicit disclosure. The presence of physical signs of abuse can also prompt concerned adults to question children about their experiences, potentially leading to disclosure and a formal report (McElvaney et al., 2020). Prompting by trusted adults has been found to increase the likelihood of disclosure in children (McElvaney et al., 2020). 5.2.1.2 Frequency In line with our hypothesis, children reporting CSA experienced a higher frequency of abuse before a report could be made. More frequent abuse has been found to contribute to a lack of trust in adults, which can potentially delay disclosures of sexual abuse (Jernbro et al., 2017). Frequent abuse often accompanies delays of disclosure which were found to be significantly longer in CSA. In the case of physical abuse, as it most often occurs within the context of discipline, it may be harder to distinguish what the child or family might perceive as normal 45 disciplinary action compared to sexual abuse, resulting in a lower reported frequency of incidents. 5.2.2 Relation to perpetrator It was hypothesized that perpetrators of CPA would have a closer relationship with the child compared to perpetrators of CSA. This hypothesis was supported, as perpetrators of CPA were found to be more closely related to the victims than perpetrators of CSA. This finding aligns with previous discussions highlighting primary caregivers as the main disciplinarians of children (Frechette et al., 2015). Previous research has indicated that the relationship to the perpetrator was a more substantial predictor of disclosure than any other variable (e.g., age, gender, and severity of abuse; Foynes et al., 2009). Given the impact of the perpetrator’s relationship with the child and the finding that children experiencing CPA are more closely related to their abusers, it is crucial to give special attention to this variable in prevention and response efforts to physical abuse. Closer relation to perpetrators in the case of CPA can result in greater difficulties disclosing, leaving the child without a trusted adult to confide in. Without a trusted adult to tell, a disclosure and subsequent report may be less likely to occur (McElvaney et al., 2014). To summarize, compared to CPA, children disclosing CSA tend to be slightly younger girls, who experience more severe abuse at a higher frequency and are not as closely related to perpetrators. Alternatively, children disclosing CPA tend to be slightly older, have an even gender distribution, experience less severe abuse at a lower frequency, and are more closely related to perpetrators. In response to the many significant differences between CSA and CPA, the current study reveals that one unified theory cannot be easily applied to both forms of abuse. 46 As such, unique disclosure theories should be considered for each form of abuse or theories that focus more so on the decision-making process of the victim might be applied. 5.3 Application of Disclosure Theory to CSA and CPA With the differential impact of age, gender, severity and frequency of abuse, and the relation to the perpetrator across different types of abuse, it becomes challenging to formulate a unified theory of disclosure without considering the varying effects of the features of the child and the abuse. For instance, boys may experience more shame and stigma associated with CSA, whereas CPA may not pose the same barriers for boys. Gendered theories regarding disclosure might help to explain the large difference between the spread of gender in those reporting CSA. However, gendered theories would fail to explain disclosure within a CPA context. The ‘no-maybe-sometimes-yes syndrome’ may apply here where a first timid disclosure is given, but if negative reactions are received, they result in further stigmatization (MacFarlane & Krebs, 1986). It is possible that the negative impact of male-specific barriers could be further perpetuated by coinciding negative verbal messages from peers. The relationship with the perpetrator was significantly different across abuse types. Children experiencing CPA reported a closer relationship with perpetrators than children who experienced CSA. This finding, combined with the knowledge that the relationship with the perpetrator can be predictive of when a disclosure will occur, suggests that the nature of relationship warrants particular attention (Wallis & Woodworth, 2020). For example, the BTT framework could be pulled across and may fit even better within a CPA disclosure (Foynes et al., 2009). Within the BTT framework the close relationship to the perpetrator would prevent the child from disclosing experienced abuse. 47 Due to the more multifaceted and flexible nature of many current CSA theories, there is potential that they could also be applied to CPA. For example, the Transactional Theory and Socio-Cognitive Models of disclosure consider the interplay of individual and environmental conditions that ultimately influence the decision to disclose or not disclose instances of abuse (Bussey & Grimbeel, 1995; Spaccarelli, 1994). Specifically, within the Transactional Theory, children experiencing frequent CPA evidence a pattern of child-perpetrator interactions that cause stress in the family environment (Spaccarelli, 1994). Children often develop negative cognitive appraisals and problematic coping strategies in these negative home environments where violence is pervasive. Children's negative cognitive and behavioural responses can be further compounded by choosing not to seek support. The socio-cognitive model considers disclosure the result of a decision-making process (Bussey & Grimbeel, 1995). Under this model, the child's cognitive abilities and social experiences impact their awareness of the consequences for their disclosure. As such, this model considers the unique experiences of most children and can be applied widely. 5.4 Disclosure Given the current evidence highlighting significant differences in child and abuse characteristics of those disclosing across abuse types, it is reasonable to suspect that the process of disclosure will also be substantially different. Building on previous research, this study hypothesized variations in disclosure features based on the type of abuse experienced. The analysis yielded significant disparities in delays of disclosure, and presence of prior disclosure, while no distinctions were observed in the recipient groups of disclosures. 48 5.4.1 Delays of Disclosure As hypothesized, children experiencing sexual abuse delayed disclosure significantly longer than children experiencing CPA. Average delays for children experiencing CSA were almost four years, while delays for children experiencing CPA were just over one year. These findings indicate that delays may be four times longer in cases of CSA. There are several reasons for the possibly longer delay of disclosures in cases of CSA. The first is increased feelings of shame and stigma associated with experiences of sexual abuse. As a result of the inherently taboo nature of sex and any discussion surrounding it, it may be difficult for children who are experiencing CSA to broach this subject with their parents. Alternatively, in the case of CPA, there is a higher likelihood of other evidence, such as eyewitnesses or injury (Rush et al., 2014), which may lead to an investigation sooner than the decision can be made to disclose. 5.4.2 Prior Disclosure Confirming our prediction, prior disclosures were significantly more likely to occur in cases of CSA than CPA. Accordingly, as there is greater evidence for CPA, there is less need for a prior informal disclosure before an investigation can be initiated. A safe adult may ask the child about the abuse once the signs of it are apparent (Hershkowitz et al., 2007). On the other hand, in cases of CSA, there is often little evidence for this crime, and so disclosure is required for a safe adult to be alerted of the abuse and report to the authorities (Dubowitz et al., 1992). Once an investigation is initiated, a safety plan for the child may be put into place, and resources can be obtained for them. Hence, it was hypothesized that a previous informal disclosure would be more likely to occur in cases of CSA than for CPA. This hypothesis was fully supported, with children making a prior disclosure in significantly more cases of CSA than CPA. Seventy-seven percent of children experiencing CSA made a prior disclosure before an investigation was 49 initiated, while only 33% of children experiencing CPA made a prior disclosure. In the current study, disclosures were substantially more important for the initiation of investigations into cases of CSA. Perhaps this result is indicative of the signs of physical abuse being more crucial to the reporting of CPA. Reporting of CPA often occurs without a first informal disclosure indicating that it may be injury or other evidence that initiates a report. For CSA, response efforts should be targeted at how to obtain and receive disclosures from children. This might include creating an ongoing environment of trust between primary caregivers and children. For CPA, response efforts might be better served at disseminating signs of abuse to target disclosure recipient audiences. 5.4.3 Disclosure Recipients As discussed above, it is essential to identify potential disclosure recipient groups so that response efforts can be targeted toward these individuals. Based on previous research, it was predicted that the largest group of disclosure recipients would be peer groups (Bottoms et al., 2016). Current findings did not support this hypothesis. For both CSA and CPA, the most common disclosure recipient was non-offending caregivers. This finding may, in large part, be a consequence of the current study’s sample. Our sample is one in which a report of abuse was made, either by the child or on behalf of the child. Adults who receive disclosures are more likely to report abuse because of their greater ability to understand it and access resources on behalf of the child. Alternatively, our file information may be lacking in detail regarding the first informal disclosure in some cases. As noted by Manay and colleagues (2021), children may initially disclose to a peer group and then, upon positive reactions or advice, may choose to disclose to an adult. Regardless non-offending caregivers are the most noted adult group to make 50 a report of abuse. As such, they are a particularly crucial disclosure recipient group to target for interventions and response efforts. 5.5 Conclusion Children who disclose sexual and physical abuse were found to be significantly different along several child and abuse characteristics (i.e., age, gender, severity and frequency of abuse, and relation to the perpetrator). Children who disclosed CSA were significantly younger than those disclosing CPA. There was a more even spread of gender within physical abuse than sexual abuse, which was reported disproportionally more by girls than boys. Children who disclosed CSA also reported significantly more severe abuse, but children disclosing CPA reported a higher frequency of abuse. Children disclosing CPA were more closely related to perpetrators than those disclosing CSA. Not only were there considerable differences between abuse types, but disclosures themselves evidenced substantial distinctions. Delays of disclosure were significantly longer, and there was a higher likelihood of a prior disclosure in CSA cases. Across abuse types, the most common disclosure recipient group was non-offending caregivers. Study 2 will focus on this most reported disclosure recipient group, and how they respond to disclosures of CSA and CPA. Specifically, Study 2 will consider child and abuse characteristics as they have been shown through Study 1 to differ across abuse types and to impact disclosures. 51 CHAPTER 6: STUDY 2 – NON-OFFENDING CAREGIVER RESPONSES TO DISCLOSURES OF ABUSE The decision to disclose is complex for children and youth experiencing abuse. Adults in positions of trust often play an essential role in disclosures. Ideally, the steps from identification to asking involve a conversation where the child feels they have found someone they can trust and confide in (Jensen et al., 2005). Within a relationship that is perceived as trusting, the child can be more confident that they will be taken seriously and believed. In this process, the trusted adult is often the gatekeeper to formal help-seeking (Alaggia, 2002; McElvaney & Nixon, 2020). While the child may initially disclose to seek support (and indeed, non-offending caregivers are a significant source of informal support), these trusted adults will often also be the ones to decide whether a report is made on the child's behalf. Furthermore, the nature of how disclosure recipients respond (for example, whether they appear supportive or not), will often dictate future disclosures (Alaggia, 2002). The current study aims to determine how disclosure recipient groups respond to disclosures of abuse. Study 1 demonstrates that non-offending caregivers make up the largest group of disclosure recipients among reported cases of abuse. After receiving a disclosure, the recipient will form their own feelings and opinions about the abuse, which can have both direct and indirect effects on the child disclosing (Bick et al., 2014; Cyr et al., 2016; Kim et al., 2007). The most obvious impact will be increasing or decreasing the likelihood of a report and subsequent formal disclosure. Despite disclosure recipients' often vital part in bringing abuse to light, there is a paucity of research examining their role in the process of potentially reporting it. The vast majority of extant research and theory to date has primarily focused on the victim's decision to report (Finkelhor et al., 2001; Xie & Baumer, 2019). Incredibly limited 52 research has considered how disclosure recipients might decide to report or factors that may inhibit trusted adults from reporting childhood maltreatment. 6.1 Vicarious Trauma Many non-offending caregivers and other close family members and friends will find themselves the primary source of support for children who have disclosed abuse. At the same time, they may also be dealing with their own feelings about the abuse (Fuller, 2016). A high proportion of mothers have report psychological difficulties following their child’s disclosure. For example, Hebert and colleagues (2007) found that half their sample demonstrated symptoms of general distress. Another study noted that one-third of mothers reported PTSD (Cyr et al., 2016). Kim and colleagues (2007) and Santa-Sosa and colleagues (2013) found that between 22 and 40% of mothers display symptoms of depression. Negative feelings may be further exacerbated when the perpetrator is a close loved one. In fact, one study found additional post-disclosure distress the more closely related the caregiver is to the perpetrator (Hebert et al., 2007). Fewer studies have examined the impact of disclosures on fathers, but there is some evidence of lower psychological distress following disclosures (Cyr et al., 2016; Manion et al., 1996). Although there is potential for a substantial negative impact on caregivers, some factors also predict more positive post-disclosure functioning. Two areas that increase positive outcomes for caregivers are their satisfaction with their perceived parenting roles, and their ability to support their children emotionally (Manion et al., 1996). Research is needed to examine how non-offending caregivers respond to disclosures of abuse and what other factors might mediate these reactions. This is especially important as these responses have been shown to directly 53 impact the recovery of the child and caregiver post-disclosure (Mathews et al., 2013; Tal et al., 2018). 6.2 Making Sense of the Disclosure McElvaney and Nixon (2020) examined parents’ experiences of receiving disclosures of sexual abuse through semi-structured interviews. Three main themes emerged from these interviews. First, is a need to make sense of the abuse in retrospect and understanding why their child may have delayed a disclosure, as is often the case in sexual abuse (Wallis & Woodworth, 2020). The first stage also includes noticing that something is wrong and signs that abuse might be occurring (McElvaney & Nixon, 2020). Next, parents must negotiate their parental identity as protectors. This view as a protector is often changed after the discovery of abuse, with trust in others being uniquely impacted. Some parents may handle this by becoming overprotective, such as not letting the child out of their sight. In this study, parents also blamed themselves for not noticing that abuse was occurring. Finally, navigating services is a prominent theme, which involves reporting to the police or seeking alternative forms of help, such as through child protection services. Often within these independent agencies, parents reported barriers such as not knowing how to access them, delays in agencies responding, and even experiences of blame from agency workers (McElvaney & Nixon, 2020). These factors can make it difficult for non-offending caregivers to respond to disclosures supportively. 6.3 Responding to Disclosures Once a safe adult receives an informal disclosure, they might respond in several ways. Alaggia (2002) conducted extensive qualitative interviews with mothers of children who had experienced intrafamilial abuse. They concluded that support is multidimensional and incorporates cognitive, affective, and behavioural aspects. Cognitive or belief responses range 54 from an unconditional belief of the child’s disclosure to questioning some aspects of the child’s disclosure and the veracity of their disclosure. Affective responses acknowledge the seriousness of the abuse and the child’s resulting distress. In other cases, parents might minimize distress and assign blame; in some extreme cases, they may respond with anger and rejection. Finally, behavioural responses may include allowing or inhibiting contact between the child and abuser and help-seeking behaviours such as reporting or accessing post-disclosure treatment on behalf of the child. These responses can be dynamic, oscillating between supportive and unsupportive reactions. For example, one study noted that parents might be initially very supportive post-disclosure (Mathews et al., 2013; Mathews et al., 2016). However, in some cases over time this support can been slowly withdrawn as a need to move beyond what happened becomes stronger (Mathews et al., 2016). It is possible that as the consequences for disclosure arise (e.g., having a primary financial earner removed from the home or a child), support may be revoked. Exploring factors that might lead to or inhibit supportive behaviours displayed by non-offending caregivers is crucial. Various theories have been proposed that might help us better explore and understand how reporting might unfold or why it may not occur at all. 6.4 Theories of Reporting In an attempt to understand and explain the experience of reporting violent crime, multiple theories have been proposed. Unfortunately, no theories of reporting have been developed to address CSA or CPA, but rather violent crime more generally experienced by older adolescent groups. These theories usually fall into several main lines of consideration, the most common of which involves the impact of situational characteristics of the crime itself and factors associated with its seriousness. 55 One situational characteristic that has often been considered is the severity of the crime. Gottfredson and Hindelang (1979) were one of the first to propose that there is a relationship between the seriousness of crime and victim reporting. Using National Crime Survey data, they observed that victims suffer varying degrees of monetary loss, physical injury, emotional distress, and other adverse outcomes. They found that decisions to report crimes to police were determined more so by the direct consequences of crime for victims rather than other more distant social factors. This finding has been replicated in subsequent studies (e.g., Bachman, 1993; Copes et al., 2001; Gartner & MacMillan, 1995; Skogan, 1984). Based on the above, the rational approach posits that a victim’s decision to report involves weighing the pros and cons. Depending on the perceived benefits of reporting (e.g., protection for self and others, property recovery, victim compensation, and justice) and the anticipated costs (e.g., risk of retaliation, fear, shame or embarrassment, and time and resources to participate in the legal process) victims will carefully make the decision to report. One major criticism of the rational approach to victim crime reporting is its lack of attention to emotional factors, normative conditions, and support mechanisms and environments (Xie & Baumer, 2019). The second line of research on victim crime reporting emphasizes attitudes and social-psychological factors when determining whether to report. This line of research considers the rich body of research addressing gender roles and feminist attitudes (Jensen & Karpos, 1993; Orcutt & Faison, 1988; Skelton & Burkhart, 1980). For example, higher acceptance of traditional gender roles and rape myths is associated with higher levels of victim blame (Grubb & Turner, 2012; Suarez & Gadalla, 2010), which hinders reporting. Attitudes concerning police and their legitimacy are another line of attitudinal factors proposed to impact reporting. A lack of trust or belief in police effectiveness can naturally result in fewer reports. Age and race have been found 56 to predict attitudes concerning the police most strongly (Decker, 1981; O’Connor, 2008). Police attitudes are multidimensional and encompass satisfaction with police services, views of procedural justice, police efficacy, agency performance, police characteristics, and other notable features of police practice (Reisig & Lloyd, 2009). The final stream suggests that broader social, political, and economic forces influence the decision to report. With this approach, a three-stage victim decision-making model has been proposed. Under this model, (a) first, the event must be labelled as a crime, (b) then the seriousness of the crime must be determined, and (c) finally, the course of action will be decided upon. At each of these stages, the motivational state influences the victim. The motivational state is proposed to be impacted primarily by the emotional distress and sense of loss of victims following the crime and the outsiders who might influence them. Outsiders often provide victims with advice that might influence their decisions, provide normative information, and offer or deny them socioemotional support (Ruback et al., 1984). In many cases, individuals within the victim’s immediate social circle, including friends, relatives, and bystanders, will directly advise them on whether or not they should call the police (Xie & Baumer, 2019). To tie the three streams of victim reporting research together, Xie and Baumer (2019) created a multilevel, contextualized model of crime reporting to the police as a form of help-seeking. The first two dimensions are victimization and harm, and household dysfunction. Victimization and harm are comprised of incident-level characteristics that might impact a victim’s subjective perception of how severe the incident(s) were and what their needs are. Household dysfunction consists of the victim's demographic, social, and economic characteristics, and perceptions of police and other formal resources, which all impact the ultimate decision to seek formal support when needed. The third dimension, external 57 environmental factors, includes contextual features of the victim’s interpersonal world that might influence their decision to seek formal or informal assistance. While the majority of research has addressed the first two dimensions, fewer studies have focused on the impact of external environmental factors, such as family, social networks, organizational, neighbourhood, and macro-level contexts. Current research on social networks and reporting suggest that victim-network interactions can have negative consequences, such as through victim blaming (Davis & Brickman, 1996; Littleton, 2010). Victim blame can result in a lack of reports and follow-up disclosures within forensic interviews. Social networks may even outright discourage further help-seeking of the victim. For example, adolescent groups often have a code of silence when it comes to reporting to the police and may advise each other against it (Syversten et al., 2009). Alternatively, victim-network interactions can have positive consequences, such as through providing emotional support (Kaniasty & Norris, 1992). The current study is concerned with the dyadic interaction between children and those they could potentially disclose to, with a focus on non-offending caregivers, the largest disclosure recipient group found in Study 1. Likewise, they may also be their greatest source of support post-disclosure. The integrated model addresses the dynamic process of victim help-seeking. First, it recognizes that how victims seek help will change as a function of prior help-seeking experiences (Bell et al., 2009; Hickman & Simpson, 2003; Xie et al., 2006). Second, it notes that the conditions that shape help-seeking will shift and change over time and across populations (Baumer et al., 2003; Baumer & Lauritsen, 2010; Xie, 2014). The integrated model then assumes that disclosure recipient responses shape current and future help-seeking behaviours. 58 Some theories have attempted to examine formal help-seeking within juvenile populations. Finkelhor and colleagues (2003) identified a conceptual framework outlining the barriers to formal help-seeking. Factors related to underreporting to police fall under five main categories. The first factor is related to definitional issues, that is, hesitancy to define an incident as an abusive one that professional agencies would be interested in. Definitional issues may occur when there is a misperception of shared culpability (Finkelhor et al., 2003). For example, exposure to child abuse, especially in multiple forms, may result in more externalizing behaviour in teen years (Guerra et al., 2019). As a result, physical assaults between teenagers and caregivers may be bidirectional, in which case culpability might be perceived to be shared. Alternatively, if perpetrators are also juveniles, they may not be seen as criminals, and their offence may not be viewed as a crime (Finkelhor et al., 2003). This is especially true for crime between acquaintances. When youth assault other youth, this may be categorized as bullying which falls under the second factor. The second factor is jurisdictional, in which families seek non-police resolutions such as schools or child protection agencies. For example, the most common form of childhood victimization is assault by peers or siblings (Finkelhor et al., 2010), which is more routinely dealt with by parents or schools. The third factor is developmental in nature. For younger children especially, trusted adults are the gatekeepers to reporting. On the other hand, for older children, youth subculture often discourages police reporting (Flanagan & Stout, 2009). Again, peer discouragement means parental reporting may be even more important. The fourth factor is emotional and involves feelings of shame and embarrassment that can accompany sexual abuse. Often victims report feelings of powerlessness and cynicism, that they want to avoid blame or mistreatment from the system, and that they want to avoid negative reminders of the events. Victims also report fear of repercussions for the abuse or from the 59 abuser. The final factor is material and encompasses the time and financial costs associated with reporting, such as missing work to attend a forensic interview or trial (Finkelhor et al., 2003). These factors can be applied to the two-stage model of police reporting or victim help-seeking (Finkelhor et al., 2003). The first stage, the recognition stage, involves defining the incident as an abusive one that the police or support agencies would be concerned about. Factors impacting this stage would be the seriousness of the offence, the degree of injury, prior experience of children and families with similar victimizations, and knowledge surrounding agencies. The second stage, the consideration stage, involves the nonoffending caregiver or child weighing the benefits of reporting or accessing services. Barriers occur when the costs outweigh these benefits. The stages of this model may occur simultaneously or one after the other. The result is either a report or other help-seeking, or no report or help-seeking (Finkelhor et al., 2003). Previous theories and limited research have provided potential conceptualizations and explanations for a reports' occurrence. However, previous theories are built to capture why a victim themselves may choose to report or not report, failing to address a prominent aspect of the reporting mechanism, the disclosure recipient. That is, many theories only address contextual factors impacting the victim. However, in cases of childhood abuse, disclosures and ensuing reports occur through a dyadic process between the child making an initial informal disclosure and the disclosure recipient responding. If disclosure recipients respond poorly to the child's disclosure, this can become a psychological and physical barrier to formal help-seeking behaviours (Anderson, 2016; Bick et al., 2014; Cyr et al., 2014; Tashjian et al., 2016). Further, current theories can only be applied to specific populations, such as those experiencing violent crime more generally or intrafamilial CSA and have yet to be considered in other contexts. In 60 fact, outside of CSA, little research has examined other forms of abuse, such as CPA. The current study aims to identify barriers to help-seeking in disclosure recipient populations, specifically, how child and abuse characteristics might impact non-offending caregivers' responses to CSA or CPA disclosures. 6.5 Predictors of Disclosure Responses Based on the above literature review, non-offending caregivers and other safe adults play a myriad of roles in providing informal support and accessing formal supportive agencies. It is essential to fully explore all potential factors that contribute to the hesitancy of caregivers in providing different forms of support to a child. Concerning CSA post-disclosure responses, maternal belief and protection have previously been addressed in the literature. For example, Sirles and Franke (1989) found that 78% of their sample of mothers of children who had been sexually abused believed their child’s disclosure. Notably, lower protection levels have been found in other studies, with between one-third and 56% of mothers being protective (Faller, 1988; Myer, 2016; Heriot, 1991). Some of the following key factors have in the past been found to impact belief and protective responses after disclosure of CSA. 6.5.1 Age Aligning with variables from Study 1, both child and abuse characteristics have also been found to be related to disclosure recipients’ responses. For example, the age of the mother receiving a disclosure and the child disclosing may determine whether support is given to the child. If mothers were older when they had their first child, they were more likely to display belief and protection, which may be due at least in part to maturity levels. Younger mothers (e.g., those who become mothers before 21) may not be emotionally prepared to handle stressful parenting situations (Pintello & Zuravin, 2001). Further, many of these younger mothers likely 61 would not have developed the coping skills to help them respond supportively should they need to. Interestingly, if the child abuse victim was under 12 years of age, mothers were more likely to believe their child’s disclosure and to display protective behaviours (Franke, 1989; Heriot, 1991; Salt et al., 1990). 6.5.2 Gender Supportive responses of mothers have been found to be highly dependent on the gender of the victim (Salt et al., 1990). When children are boys, they receive less protection than girls. Understandably then, CSA committed against girls is more likely to be reported than CSA committed against boys (Boney-McCoy et al., 1995; Briggs, 2008; Feiring et al., 1999; Scholes et al., 2014; Stoltenborgh et al., 2011). A substantial amount of research has found that while 1 in 3 girls and 1 in 7 boys will experience CSA before the age of 16, boys are at a much higher risk to not report the crime (Briggs, 2008; Scholes et al., 2014). This hesitancy in boys to disclose and report CSA may be primarily due to the myths associated with male experiences of sexual abuse, as discussed in Study 1. There are three primary myths associated with male experiences of CSA. The first myth is that they might become gay as other males commit most CSA. The second myth is that they are less male because of the abuse. The final myth is that they might perpetuate the cycle of abuse themselves (Davie et al., 2015; Priebe & Göran, 2008; Sivagurunathan et al., 2019). 6.5.3 Severity & Frequency Severity itself has been linked with psychological adjustment post-abuse. Specifically, the higher the severity of abuse typically the lower the child’s post-disclosure functioning. Severe CSA has been found to be associated with higher depression scores (Sciolla et al., 2011). Naar-King and colleagues (2002) noted that participants who had experienced severe versus mild 62 or moderate abuse reported more symptoms of depression and PTSD. The connection between higher symptomology and more severe abuse can be mediated through the use of positive coping strategies (Espeleta et al., 2017). Positive coping strategies are more likely to occur with positive responses from disclosure recipients. Unfortunately, while positive responses would result in more positive outcomes if abuse was severe, mothers were less likely to believe and protect their children (Franke, 1989; Heriot, 1991; Salt et al., 1990). For example, when CSA included intercourse, mothers were less likely to believe disclosures (Franke, 1989) and protect their children (Heriot, 1991; Salt et al., 1990). 6.5.4 Relation The relationship between the perpetrator and non-offending caregiver has the potential to impact how they respond to disclosures. For example, it has been posited that the more closely related, the more significant the consequences to the family for disclosure and the ensuing report (Wallis & Woodworth, 2020). Previous research has found that mothers were most likely to indicate belief when they did not have a sexual relationship with the perpetrator (Frank, 1989). Likewise, if the mother and perpetrator are sexual partners, mothers are more likely to respond with unprotective responses (Heriot, 1991; Pintello & Zuravin, 2001; Salt et al., 1990). While some research shows promise in elucidating factors that predict parental support, they are limited to narrow samples, such as intrafamilial CSA (Pintello & Zuravin, 2001). Even more concerning is the lack of research addressing predictors of parental support in the case of CPA. The current study seeks to rectify this paucity of research by identifying how the above child and abuse characteristics might impact the ability or willingness of disclosure recipients to provide support. Most importantly, to examine how these variables impact the reporting process in the largest group of disclosure recipients, non-offending caregivers. 63 6.6 Multidimensional Scaling Analysis One unique way of determining how variables such as child and abuse characteristics might be related to supportive responses is through Multidimensional Scaling (MDS) analysis. This form of analysis displays judgments of similarity between data in a figure which represents a visual map of the relationship between variables (Fitzgerald, 1987; Hout et al., 2013). Each variable is represented by a point in what is referred to as a multidimensional Euclidean space, where distance indicates how related two variables are. Variables in close geometric proximity will represent similar variables, while dissimilar variables will be far away from one another on the map (Fitzgerald, 1987; Hout et al., 2013). Researchers may then visually inspect the similarities among variables in this geometric space. Using this technique might facilitate a more enhanced understanding of how related child and abuse characteristics are to one another and to different supportive behaviours. Findings from this analysis can be used to either confirm or disconfirm the importance of specific variables to the reporting process. For example, suppose the variable’s age and relation are close to the variable reporting in geometric space. In that case, it can be concluded that these two variables are highly related to reporting behaviour, while the other variables are not. These similarities will be further explored through logistic regressions for each supportive behaviour across abuse types. 6.7 Current Study One recurrent theme throughout extant research is the role of disclosure recipients as the gatekeepers to reporting abuse (Finkelhor et al., 2003; Xie & Baumert, 2019). Non-offending caregiver reactions, behaviour, and level of support have been consistently found to predict the child's subsequent safety, recovery, and mental health functioning (Alaggia, 2002; Foynes et al., 2009; Manion et al., 1996). Yet despite the substantial role of non-offending caregivers in 64 bringing reports to light, limited to no research or theories have focused on the caregiver or even outsider perspective when deciding to report childhood abuse. Most of the research is victim centric (Finkelhor et al., 2003; Xie & Baumert, 2019) and only focuses on the decision of the victim to report rather than examining other reporting mechanisms such as through trusted disclosure recipients. The current study aims to closely examine disclosure recipients and how they might respond to disclosures of both CSA and CPA. Specifically, we will examine the largest group of disclosure recipients from Study 1, non-offending caregivers. Previous research has focused on two main supportive behaviours, belief and protection (Faller, 1988; Franke, 1989; Heriot, 1991; Myer, 2016; Pintello & Zuravin, 2001). The current study will expand on this by measuring belief and adding additional behaviours, such as assigning blame, interrupting contact, and reporting the abuse. Child and abuse-related factors will be examined in relation to different supportive behaviours, as these have been found to impact both belief and protection in previous studies (Franke, 1989; Heriot, 1991; Pintello & Zuravin, 2001; Salt et al., 1990). Further, the current study will examine these variables across abuse types. This will be done using MDS analysis, which, as outlined above, is a promising and unique technique for determining relationships among variables. 6.7.1 Hypotheses 1. The MDS procedure is exploratory in nature and so no predictions will be made regarding the configuration of the maps, beyond that we predict the resulting CSA and CPA map configurations will be different. 2. It is predicted that non-offending caregivers will display higher rates of supportive rather than unsupportive behaviours overall. 65 3. Nonoffending caregivers are predicted to be more supportive in CSA than in CPA cases, except when it comes to blame. Specifically, it is predicted that: a. Non-offending caregivers will be more likely to believe CPA disclosures. b. Non-offending caregivers will be more likely to blame children disclosing CPA, than CSA. c. Non-offending caregivers will be more likely to interrupt contact in CPA cases. d. Non-offending caregivers will be more likely to report CSA than CPA. 4. It is predicted that all non-offending caregiver responses to disclosures (i.e., belief, blame, interruption of contact, and reporting) will be impacted by child and abuse characteristics (i.e., age, gender, severity and frequency, and relation to perpetrator). More specifically, it is anticipated that some variables will become more apparent as prominent predictors of different supportive responses. 66 CHAPTER 7: STUDY 2 METHOD 7.1 Participants Study 2 utilized a subset of the sample from Study 1. This sample was drawn from the RCMP database for the greater Okanagan area in British Columbia, Canada. Files included allegations of CSA or CPA from between the years 2007 – 2018. Cases pulled included the following charges if they involved a child or youth victim: • Assault (causing bodily harm, with a weapon and aggravated assault) (ss. 265-268), sexual offences against children and youth (ss. 151, 152, 153, 155 and 170-172). Cases were removed if there was no mention of non-offending caregiver support or responses in their case file. In many cases, this removed historical reports in which the victim is now an adult or those involving older youth, who may be able to report without their caregiver’s knowledge. Of the initial n = 284 cases involving CSA, n = 201 were retained, and of the initial n = 183 cases involving CPA, n = 59 were retained for analysis. 7.2 Measures 7.2.1 Child and Abuse Characteristics Both child and abuse characteristics mentioned in Study 1 were collected. Specifically, the child’s age and gender and abuse characteristics such as abuse type, severity and frequency of abuse, and relation to perpetrator were collected from case files. In our analyses gender was coded as 1 for girls and 2 for boys. Abuse characteristics were collected according to the adapted ADI scale, as discussed in Study 1 (Chaffin et al., 1997). This scale provided a comprehensive list of CSA and CPA behaviours. Sexual abuse was measured on a 12-point scale from sexually suggestive talk, hugs, or kissing = 1, visually exposing genitals (abuser or child), voyeurism or viewing pornography = 2,… vaginal or anal intercourse (including unsuccessful attempts) = 10, 67 paraphilic sex = 11, ritual and satanic abuse or sexualized torture = 12; Chaffin et al., 1997). Physical abuse was measured along a 10-point scale from pushing or shaking = 1, excessive disciplinary spanking = 2,… batter, beatings, and other major assaults = 7, attacked with weapon = 8, burned extensively = 9, sadistic injury or torture = 10; Chaffin et al., 1997). For a full list of CSA and CPA behaviours see Appendix B and C. For the current set of analyses, continuous and ordinal variables were further collapsed in order to create larger group sizes, such that: ages were collapsed into 0 – 3, ages 4 – 6, ages 7-12, and ages 13 – 18; severity of CSA was collapsed into non-contact offences, contact but not penetrative offences, and penetrative offences; severity of CPA was collapsed into disciplinary actions, hitting & other minor assaults, and severe behaviours (e.g., those causing serious injury, burning, or threatening or attacking with a weapon); frequency of both CSA and CPA was collapsed into one incident, 2 – 9 incidents, and 10 or more incidents; and relation was collapsed into stranger, known relationship outside of the home, known relationship inside the home except for parent, and parent. 7.2.2 Non-offending Caregiver Responses The non-offending caregiver responses coded were belief of the child’s disclosure, blaming the child for the abuse, interrupting contact between the child and perpetrator, and reporting the abuse to authorities. In order to code for blame and belief, non-offending caregiver transcripts were analyzed for these messages. For example, one caregiver stated that “this would not have happened had their child listened to them.” This message was then coded as a blame response. While having a score of interrater reliability is ideal, it was impossible in this case due to the unique and sensitive data being accessed. The presence of non-offending caregiver knowledge was used in the second part of the study to divide the subsample to assess how this group of disclosure recipients respond to disclosures of abuse. 68 7.3 Procedure The current study utilized a subset of the data from Study 1. Cases were included if the non-offending caregiver had knowledge of the abuse. The primary researcher was permitted to access reported CSA and CPA cases from RCMP databases. While RCMP data is usually difficult to access, the collaboration between the Child Advocacy Centre of Kelowna, the Kelowna RCMP, and the University of British Columbia Okanagan made this possible. Special consideration was given to the security of such sensitive data, and steps were taken to protect the privacy of these files, including coding in private and restricted spaces, using a research-specific password-protected and encrypted laptop, and destroying documentation of sensitive information once converted to a quantitative format (keeping some minor comments when needed, for example minor quotations without any identifying information). Steps were also taken to protect the mental health of the primary researcher coding files. This included coding for no more than 3 hours at a time once a day and having access to mental health support when needed. Variables included from the previous dataset were the child’s age and gender, abuse type, severity and frequency of abuse, relation to the perpetrator, and non-offending caregiver response information (knowledge of abuse, belief of disclosure, blame of child, interrupting contact, and reporting abuse). Variables were coded onto a researcher-created coding sheet and did not contain any directly identifying information. These coding sheets were then transferred to an Excel spreadsheet. Once entered, the original coding sheets were deleted. With these steps, the current study was previously given ethical approval (e.g., H18-00273). This dataset was then further broken down after a prominent disclosure recipient group was identified, non-offending 69 caregivers. Once a subset of data was identified and pulled, variables were collapsed into ordinal groups as described above. 7.4 Planned Analysis 7.4.1 Descriptive Statistics Descriptive statistics were employed to examine rates of non-offending caregiver responses. Four behaviours were examined, believing, blaming, interrupting contact, and reporting the abuse. 7.4.2 Multidimensional Scaling Analysis Multidimensional scaling analyses are a set of procedures that can spatially display how similar-dissimilar a set of variables are (Fitzgerald & Hubert, 1987). Multidimensional scaling analyses were used to explore the relationship between child and abuse characteristics, disclosure-related factors, and supportive behaviours. A scalogram was used to display the associations between variables, represented by points in Euclidean space. The distances between two points represented their degree of statistical association. This allows researchers to look at the data to determine whether patterns exist. First, a correlation matrix was created for child and abuse characteristics and other variables of interest, such as abuse type and non-offending caregiver responses. This then formed the basis of the data for this procedure. The smacof and mass packages in R were used to conduct the MDS analyses. The code utilized for this procedure can be found in Appendix D. 7.4.3 Test of Two Proportions Tests of Two Proportions allow researchers to examine differences in binomial proportions of two independent groups across a dichotomous variable. A Test of Two Proportions was run on each non-offending caregiver response. The groups were consistently 70 CSA and CPA, while the dichotomous variable that will change across analyses was non-offending caregiver’s responses (i.e., belief or disbelief, blame or no blame, interruption of contact or no interruption, and reporting or no reporting). Effect sizes were reported using differences of proportions. 7.4.4 Logistic Regressions The MDS procedure was followed up by logistic regressions in order to discern the exact relationships among child and abuse variables, and non-offending caregiver responses across abuse types. Specifically, logistic regressions allowed us to determine whether child and abuse characteristics that were found to be significantly different across abuse types could predict whether a non-offending caregiver responded with a supportive or unsupportive response. Four logistic regressions were run for each of the four dichotomous nonoffending caregiver responses (i.e., believing versus not, blaming versus not, interrupting contact versus not, and reporting abuse versus not). This will be done for CSA and CPA. As logistic regressions need a recommended minimum of 15 cases per category, we collapsed the continuous variables into ordinal ones. Age was changed from continuous into age categories of 1 – 3 years, 4 – 6 years, 7 – 12 years, and 13 – 18 years. The severity of abuse was collapsed into a 3-point ordinal scale (previously, severity was rated on two different scales with a different number of scale points, making them incomparable), and frequency was grouped into one incident, 2 – 9 incidents, and 10 or more incidents. Finally, the relation with the perpetrator was collapsed into strangers, known relationships outside of the home, in-home relationships except for caregivers, and primary caregivers. Receiver Operating Curves (ROC)s were also reported, and they are graphs that display performance of a classification model at different classification thresholds. 71 CHAPTER 8: STUDY 2 RESULTS 8.1 Descriptive Statistics 8.1.1 Non-offending Caregiver Responses to Sexual Abuse Disclosures Of the N = 284 cases of CSA, n = 211 non-offending caregivers had knowledge of the abuse. Of the n = 211 non-offending caregivers with knowledge of the abuse, n = 165 believed their child’s disclosure, n = 25 did not believe their child’s disclosure, and n = 21 did not indicate whether they believed their child’s disclosure or not. Of this same group, n = 5 indicated they blamed their child for the abuse, n = 153 did not blame their child, and n = 53 did not indicate either way. Fifty-two non-offending caregivers interrupted contact between the child and perpetrator, n = 27 did not when their child still had contact, and n = 132 did not indicate or were not in a situation that required it. Finally, of non-offending caregivers that had knowledge of the abuse, n = 100 reported it, n = 84 did not report the incident, and in n = 27 cases the caregiver did not report but it was also not required in this situation (e.g., they were an adult when disclosing). Review Table 4 for non-offending caregiver responses. 8.1.2 Non-offending Caregiver Responses to Physical Abuse Disclosures Of the N = 183 cases of CPA, n = 59 non-offending caregivers had knowledge of the abuse. Of the n = 59 non-offending caregivers with knowledge of the abuse, n = 23 believed their child’s disclosure, n = 2 did not believe their child’s disclosure, and n = 34 did not indicate whether they believed their child’s disclosure or not, in this case many non-offending caregivers were witness to the physical abuse. Of this same group, n = 4 indicated they blamed their child for the abuse, n = 17 did not blame their child, and n = 38 did not indicate either way. Six non-offending caregivers interrupted contact between the child and perpetrator, n = 33 did not when their child still had contact, and n = 20 did not indicate or were not in a situation that required it. 72 Finally, of non-offending caregivers that had knowledge of the abuse, n = 29 reported it, n = 29 did not report the incident, and in n = 1 case the caregiver did not report but it was also not required in this situation. Review Table 4 for non-offending caregiver responses. 8.2 Multidimensional Scaling Analysis 8.2.1 Multidimensional Scaling Analysis with Abuse Type as a Variable A correlation matrix was created using a nonparametric correlation Spearman’s rho. This matrix included the main variables of interest (type of abuse, gender, age, severity and frequency of abuse, relation to perpetrator, and non-offending caregiver responses, belief, blame, interrupting contact, and reporting abuse). The correlation matrix is provided in Table 5. Several small but statistically significant correlations were found. Gender had a small but statistically significantly correlated with age, ρ = -.164, p = .008. Gender had a small but statistically significant correlation with relation, ρ = .209, p < .001. Gender had a moderate statistically significant correlation with abuse type, ρ = .444, p < .001. Age also had a small but approaching moderate statistically significant correlation with frequency, ρ = -.276, p < .001. Age and relation also had a small but statistically significant correlation, ρ = -.194, p = .002. Age had a small but statistically significant correlation with contact interrupted, ρ = -.142, p = .022. Severity and frequency had a small but statistically significant correlation, ρ = .169, p = .008. Severity had a small but statistically significant correlation with abuse type, ρ = -.214, p < .001. Frequency had a moderate statistically significant correlation with relation, ρ = .306, p < .001. Relation had a moderate statistically significant correlation with abuse type, ρ = .420, p < .001. Relation also had small but statistically significant correlations with the non-offending caregiver responses belief, ρ = -.201, p < .001, blame, ρ = .130, p = .037, and reporting, ρ = -.149, p = .017. Abuse type had a small but statistically significant correlation with interrupting contact, ρ = -.142, p = 73 .023. Finally reporting had small but statistically significant correlations with belief, ρ = .248, p < .001, and contact interrupted, ρ = .138, p = .027. A dissimilarity (or distance) matrix was then created in R using the pairwise correlation method. The first 9 eigenvalues were more similar, 2.08, 1.69. 1.32, .998, .865, .805, .674, .635, and .424, then the 10th eigenvalue, 4.44e-15. As there are only 10 different variables this indicates only two are clumping together and there are 9 clusters. Shepards plots were created to determine which MDS model had the best fit (Figure 1). The stress value indicated that ordinal MDS was the best with a stress value of .14 indicating our model provided a good representation in reduced dimensions. Although a 3-dimensional representation fits our model better, it is more difficult to interpret and so the 2-dimensional ordinal MDS model was retained. As for the MDS configuration, there were several patterns worth noting as can be seen in Figure 2. First Abuse type and gender were clustered in the upper right quadrant of the MDS configuration. The supportive responses of belief, reporting and interrupting contact were all closely located on the left side of the model. Relation, blame and frequency of abuse were spread out in the lower right quadrant. Severity and age were located opposite one another and far away form other variables in the model. 8.2.2 Multidimensional Scaling Analysis on CSA The same process was carried out for CSA and CPA separately. This was done for two reasons. First to see if there were differences across abuse types. Second, to determine if any critical distances changed through inclusion of both abuse types. Ordinal MDS was utilized in order to compare all models. First, a Spearman’s rho correlation matrix was created. This matrix can be viewed in Table 6. Gender had a small but statistically significant correlation with age, ρ 74 = -.216, p = .002. Age had moderate statistically significant correlations with frequency, ρ = -.305, p < .001, and relation, ρ = -.305, p < .001. Age also had a small but statistically significant correlation with the non-offending caregiver response interrupting contact, ρ = -.144, p = .042. Frequency had a moderate statistically significant correlation with relation to perpetrator, ρ = .368, p < .001 and a small but statistically significant correlation with belief, ρ = -.209, p = .003. Relation had small but statistically significant correlations with belief, ρ = -.280, p < .001, and reporting, ρ = -.172, p = .015. The non-offending caregiver response belief had small but statistically significant correlations with blame, ρ = -.289, p < .001, and reporting, ρ = -.271, p < .001. Finally contact interrupted had a small but statistically significant correlation with reporting, ρ = .149, p = .035. Next, a dissimilarity (or distance) matrix was then created in R using the pairwise correlation method. The first 8 eigen values were relatively similar, 2.017, 1.54, 1.15, .967, .868, .754, .686, and .567, then the 9th eigenvalue, 2.66 e-15. This indicates there are 8 major clusters. The stress value was reported as .101 for the ordinal MDS model indicating our model provides a good representation of the data in reduced dimensions. Some patterns in the MDS configuration were noted (Figure 3). First, the most prominent cluster was frequency and relation in the bottom right quadrant of the MDS configuration. Three supportive non-offending caregiver responses, belief, reporting and interrupting contact, were grouped in the lower left quadrant of the MDS configuration with gender nearby. Blame, and severity were in the upper quadrant of the MDS configuration. Age and gender were opposite one another and both spaced further away from the other variables. 75 8.2.3 Multidimensional Scaling Analysis on CPA First, a Spearman’s rho correlation matrix was created. This matrix can be viewed in Table 7. Gender had a moderate statistically significant correlation with relation, ρ = .306, p = .021. Severity of abuse had a moderate statistically significant correlation with frequency, ρ = .359, p = .017. Frequency and the non-offending caregiver response, reporting had moderate but approaching large correlation, ρ = -.500, p = .001. Next, a dissimilarity (or distance) matrix was then created in R using the pairwise correlation method. The first 7 eigenvalues were similar, 2.34, 2.08, 1.297, 1.016, .941, .764, .617, while the last two eigenvalues were different, 1.33 e-15, and -.2758. This indicates there were 7 major clusters of variables. The stress value was .146 for the ordinal MDS model, indicating our model provides a good representation of the data in reduced dimensions. As for the MDS configuration, there were several patterns worth noting including one major cluster of variables (Figure 4). Gender, relation, and blame were all clustered together in the upper left quadrant of the MDS configuration. Frequency and severity were located closely together in the lower left quadrant of the MDS configuration. Contact interrupted, in the upper right quadrant was dispersed among reporting, belief and age in the right quadrant of the MDS configuration. Gender was in opposition to belief, being far away. Finally, frequency and reporting were in opposite quadrants of the MDS configuration. 8.3 Test of Two Proportions 8.3.1 Belief A Test of Two Proportions was run using abuse type as the grouping factor and belief as the dichotomous variable of interest. Samples did not meet the minimum count expectancy of > 5, with a minimum expected count of 3.3. If the minimum expected count is below the minimum, 76 we would not be able to accurately interpret the results of this analysis. As such, we will report findings from Fisher’s exact test. The difference between the two independent binomial proportions was not statistically significant (p > .05). 8.3.2 Blame A Test of Two Proportions was run using abuse type as the grouping factor and blame as the dichotomous variable of interest. Samples did not meet the minimum count expectancy of > 5, with a minimum expected count of .83. One-hundred sixty-nine cases split into those experiencing CSA (n = 149) and CPA (n = 20). Of the 149 CSA cases, n = 4 (2.7%) blamed their child, while the remaining n = 145 did not (97.3%). Of the n = 20 CPA cases, n = 3 (15%) blamed their child, while the remaining n = 17 did not (85%). According to Fisher’s exact test the difference between the two independent binomial proportions was statistically significant (p = .037). However, if we were to account for Type 1 errors, .05/4= .0125, this finding would no longer be considered significant. 8.3.3 Interrupting Contact A Test of Two Proportions was run using abuse type as the grouping factors and interrupting contact as the dichotomous variable of interest. Our cases met the sufficient sample size of > 5, with the minimum expected count of 18. The test of two proportions used was the chi-square test of homogeneity. One-hundred and ten children who have experienced abuse were split into those experiencing CSA (n = 74) and CPA (n = 36). Of the n = 74 CSA cases, n = 49 (66.2%) interrupted contact, while the remaining n = 25 did not (33.8%). Of the n = 36 CPA cases, n = 6 (16.7%) interrupted contact, while the remaining n = 30 did not (83.3%). The difference in proportions was statistically significant, .495, p < .001. When accounting for Type 1 errors this finding was still significant. 77 8.3.4 Reporting A Test of Two Proportions was run using abuse type as the grouping factor and reporting as the dichotomous variable of interest. Our cases met the sufficient sample size of > 5, with the minimum expected count of 23.52. The test of two proportions used was the chi-square test of homogeneity. Two-hundred and twenty-five children who have experienced abuse were split into those experiencing CSA (n = 171) and CPA (n = 54). Of the n = 171 CSA cases, n = 98 (57.3%) reported the abuse, while the remaining n = 73 did not (42.7%). Of the n = 54 CPA cases, n = 29 (53.7%) reported the abuse, while the remaining n = 25 did not (46.3%). The difference in proportions was not statistically significant, .036, p = .641. 8.4 Logistic Regression 8.4.1 Believing CSA A logistic regression was performed to ascertain the impact of gender, age, severity, frequency, and relation to the abuser on the likelihood of a non-offending caregiver believing a child’s disclosure of sexual abuse. There were 10 standardized residuals with a value of -2.036 - -2.488 standard deviations, which were all kept in the analyses. The logistic regression model was statistically significant, χ2(5) = 31.873, p <. 001. See Table 8 for full report of findings and Figure 5 for the ROC curve. The model explained 37.3% (Nagelkerke R2) of the variance in believing disclosures of sexual abuse and correctly classified 92.3% of cases. Sensitivity was 98.9%, specificity was 7.1%, positive predictive value was 93.26% and the negative predictive value was 33.33%. Of the 5 predictor variables only 3 were statistically significant: Age of child at first offence, relation to perpetrator and frequency of abuse. Increased age of victim was associated with a lower likelihood of believing the child’s disclosure. Closer relation between child and perpetrator (also caregiver and perpetrator) was associated with a lower likelihood of 78 believing disclosures of sexual abuse. The more closely related the child and perpetrator the less likely the non-offending caregiver was to believe the sexual abuse disclosure. When abuse occurred more often the non-offending caregiver was also less likely to believe the disclosure. When considering reporting of abuse the area under the ROC curve for sexual abuse was .906, 95 % CI [.857, .955], this is considered an outstanding level of discrimination according to Hosmer and colleagues (2013). Large standard errors in the case of gender could be due to low numbers of males in the unbelieving group. 8.4.2 Believing CPA A logistic regression was unable to be performed to ascertain the impact of gender, age, severity, frequency, and relation to the abuser on the likelihood of a non-offending caregiver believing a physical abuse disclosure. This was because there were not enough caregivers who indicated they did not believe the child’s disclosure. Possible reasons why will be addressed within the discussion. 8.4.3 Blaming in CSA A logistic regression was performed to ascertain the impact of gender, age, severity, frequency, and relation to the abuser on the likelihood of a non-offending caregiver blaming the child for the sexual abuse. Three outliers were identified and were removed from analysis. The logistic regression model was then found to be statistically significant, χ2(5) = 12.531, p = .028. The model explained 100% (Nagelkerke R2) of the variance in blaming the child for experiencing sexual abuse and correctly classified 99.5% of cases. Sensitivity was .0%, specificity was 100%, positive predictive value was 0% and the negative predictive value was 99.48%. None of the 5 predictor variables were statistically significant on their own. When considering reporting of abuse the area under the ROC curve for sexual abuse was .085, 95 % CI 79 [1.00, 1.00], this suggests no discrimination according to Hosmer and colleagues (2013). When reviewing the raw data, there were 0 events in some groups which may result in perfect prediction of events, thus the effect may exist in the population, but our data are not powerful enough. 8.4.4 Blaming in CPA A logistic regression was performed to ascertain the impact of gender, age, severity, frequency, and relation to the abuser on the likelihood of a non-offending caregiver blaming the child for experiencing physical abuse. The logistic regression model was not statistically significant, χ2(5) = 9.403, p = .094. 8.4.5 Interrupting Contact in CSA A logistic regression was performed to ascertain the impact of gender, age, severity, frequency, and relation to the abuser on the likelihood of a non-offending caregiver interrupting contact in the case of sexual abuse. The logistic regression model was not statistically significant, χ2(5) = 5.452, p = .363. 8.4.6 Interrupting Contact in CPA A logistic regression was performed to ascertain the impact of gender, age, severity, frequency, and relation to the abuser on the likelihood of a non-offending caregiver interrupting contact in the case of physical abuse. The logistic regression model was not statistically significant, χ2(5) = 7.866, p = .164. 8.4.7 Reporting in CSA A logistic regression was performed to ascertain the impact of gender, age, severity, frequency, and relation to the abuser on the likelihood of a non-offending caregiver reporting sexual abuse. The logistic regression model was significant, χ2(5) = 12.085, p = .034. See Table 80 9 for full report of findings and Figure 5 for the ROC curve. The model explained 8% (Nagelkerke R2) of the variance in reporting sexual abuse and correctly classified 58.2% of cases. Sensitivity was 57.14%, specificity was 61.4%, positive predictive value was 57.65% and the negative predictive value was 59.05%. Of the 5 predictor variables only 1 was statistically significant: Increased relation between child and perpetrator (also caregiver and perpetrator) was associated with a decreased likelihood of reporting sexual abuse. The more closely related the child and perpetrator the less likely the non-offending caregiver is to report the sexual abuse. When considering reporting of abuse the area under the ROC curve for sexual abuse was .644, 95 % CI [.567, .721], this is considered a poor level of discrimination according to Hosmer and colleagues (2013). 8.4.8 Reporting in CPA A logistic regression was performed to ascertain the impact of gender, age, severity, frequency, and relation to the abuser on the likelihood of a non-offending caregiver reporting physical abuse. The logistic regression model was significant, χ2(5) = 18.31, p = .003. See Table 10 for full report of findings and the ROC curve can be found in Figure 6. The model explained 45.4% (Nagelkerke R2) of the variance in reporting physical abuse and correctly classified 77.3% of cases. Sensitivity was 54.7%, specificity was 61.4%, positive predictive value was 74.07% and the negative predictive value was 82.35%. Of the 5 predictor variables only one was statistically significant: frequency of abuse (as shown in Table 10). Increased frequency of abuse was associated with a decrease in the likelihood of a non-offending caregiver making a report of physical abuse. When considering reporting of abuse the area under the ROC curve for physical abuse was .834, 95 % CI [.71, .959], this is considered an excellent level of discrimination according to Hosmer and colleagues (2013). 81 82 CHAPTER 9: STUDY 2 DISCUSSION The current study aimed to explore how non-offending caregivers responded to disclosures of child abuse. Specifically, it considered supportive versus unsupportive responses, which included believing the child’s disclosure, blaming the child, interrupting contact between the child and perpetrator, and reporting the abuse to authorities. Overall, caregivers responded to disclosures of abuse with belief and withheld blame. However, unsupportive responses were also noted. For instance, contact was interrupted less often in CPA, while across abuse types just under half the sample did not report the abuse to authorities after receiving a disclosure. Both child and abuse characteristics were found to impact the likelihood of protective behaviours of disclosure recipients (Franke, 1989; Heriot, 1991; Salt et al., 1990). For CSA, the relationship between the child and perpetrator was found to significantly impact the caregivers’ decision to report the abuse. Whereas for CPA, the frequency of abuse was found to have a significant impact on the non-offending caregivers’ decision to report. 9.1 Multidimensional Scaling Analysis – Examining Patterns of Child and Abuse Characteristics, and Non-offending Caregiver Responses Multidimensional scaling analysis was carried out three times with abuse type included as a variable and then again for each abuse type separately (e.g., CSA and CPA). This was done for two reasons. First, to determine which variables are crucial to target across abuse types and second, to assess whether similar theories can be applied to each form of abuse. It was predicted that different patterns would emerge across abuse types due to the substantial differences between CSA and CPA noted in Study 1. The high variability in substantial groupings supported the previous prediction that across abuse types child and abuse characteristics and disclosure recipient responses would differ. 83 9.1.1 Abuse as Variable 9.1.1.1 Child Characteristics When abuse was included as a variable, several loose groupings emerged. The closer variables are clustered together, the more related those variables are within an MDS procedure. The most prominent cluster was abuse type and gender, revealing that disclosure of abuse is highly related to the gender of the child experiencing it. When examining the proportions of boys versus girls reporting across abuse types, as found in Study 1, boys reported CSA significantly less often than they reported CPA. Lower rates of reporting among boys could be for two reasons. The first reason could be that boys do not experience CSA at as high a rate as girls. However, the current study found that the proportion of boys reporting was less than in the general population of Canada based on the General Victims Survey (2019). Another possible explanation for a smaller proportion of boys reporting CSA than CPA is the inherently higher shame, stigma, and embarrassment attached to sexual abuse (Boney-McCoy et al., 1995; Briggs, 2008; Feiring et al., 1999; Stoltenborgh et al., 2011). For boys, greater endorsement of male-specific myths associated with sexual abuse often results in non-disclosure and poorer post-abuse functioning (Sgoi et al., 1982). Similarly, within this MDS grouping, non-offending caregivers are obviously highly unlikely to report abuse that they do not believe happened. The second finding of note within the MDS was that age of the child, was relatively placed relatively far from all other variables. While the direction of the relationship from this visual grouping was unclear, an examination of the correlation table used to generate the MDS map revealed that age was negatively correlated with belief and reporting, as well as severity of abuse. As children aged, non-offending caregivers were less likely to both believe and report disclosures of child abuse. Previous research regarding belief and protection has found similar 84 results with children under 12 eliciting more support from mothers than older youth (Coohey & O’Leary, 2008; Franke, 1989; Heriot, 1991; Salt et al., 1990). While previous research was conducted on purely CSA samples, this finding that younger children were more supported was consistent across abuse types. Our current set of findings would also indicate that as children age, abuse becomes less severe, however this may be because more severe abuse is less often reported among older children. More research is needed to compare cases of abuse that have and have not been reported to ensure our findings may generalize to a larger sample of non-reported cases. 9.1.1.3 Abuse Characteristics Frequency of abuse, relation to perpetrator and blame were located closely together on the right lower quadrant of the MDS model. Frequency of abuse and relation to perpetrator are often correlated as consistent access is required for multiple offences to occur. Blame evidenced small but significant positive correlations with relation and frequency. Positive correlations indicate that when children are more closely related to perpetrators and experience a higher frequency of abuse, they are also more likely to experience blame from non-offending caregivers. In other words, more frequent abuse committed by close relatives may result in slightly higher victim blaming attitudes. Finally, the remaining non-offending caregiver responses, belief, interruption of contact, and reporting of abuse were closely located on the left quadrant of the MDS model. As reporting is located between belief and interruption of contact, this indicates that reporting itself, is highly reliant on whether the caregiver believes that child’s disclosure, and if they report the abuse, they will also likely interrupt contact. 85 9.1.2 MDS on CSA 9.1.2.1 Child Characteristics Several main findings emerged from the MDS procedure. First, the child’s age, and gender were relatively spread out in the MDS map. This wide dispersion of variables indicates that they are dissimilar to one another and the remaining variables under consideration. Age was negatively related to all variables, except blame which was coded opposite of the other supportive responses. As children aged, they received less support across all forms of support. These findings may indicate that most supportive responses to disclosures of CSA are highly dependent on the gender of the child experiencing the abuse. When reviewing the correlation matrix, this relationship was negative, indicating that it may be more difficult to respond supportively to disclosures of abuse when the victim is a boy. Findings from both Study 1 and Study 2 demonstrate that theories addressing disclosure and support need to include some discussion of gender-specific barriers, including increased shame and stigma, as well as lack of support from disclosure recipients. These findings have been echoed in previous studies, which found that boys received less protection than girls, most often resulting in more reports of abuse experienced by girls (Salter, 1992; Sgoi et al., 1982; Stoltenborgh et al., 2011). 9.1.2.2 Abuse Characteristics Within the CSA MDS model, the major cluster that emerged included the relationship between the child and perpetrator and the frequency of the abuse. When reviewing the correlation matrix, the relationship between the child and perpetrator and the frequency of abuse were significantly and positively correlated. This finding indicates that more frequent abuse is often carried out by perpetrators who may be more closely related to the child. Consequently, the more closely related a perpetrator and child are, the more frequent abuse might become (Wallis 86 & Woodworth, 2020). More frequent abuse might be due to familiar perpetrators' greater access to the child being victimized. These findings have implications for understanding CSA, as not only has it been found to be committed often by intrafamilial perpetrators, but also at a higher rate. Severity and blame were closely located within the MDS model for CSA. However, when reviewing the correlation matrix, this relationship was not significant. This may indicate that when abuse is more severe, blame may also be more likely in cases of CSA. 9.1.2.3 Non-offending Caregiver Responses Finally, reporting of abuse was again closely grouped with interrupting contact and believing the child’s disclosure. These correlations among variables were significant and positive, which again implies that reporting is highly reliant on believing the child’s disclosure and will also likely result in interruption of contact. Taken together, these findings indicate that supportive behaviours are highly reliant on one another. 9.1.3 MDS on CPA From the MDS model of CPA, one major cluster emerged, with the majority of other variables being evenly spread throughout the Euclidean space. The major cluster consisted of the gender of the child, the relation between the child and perpetrator and blame. This finding is of particular importance as experiences of blame have been associated with a lack of reports and worse post-disclosure functioning (Alaggia, 2002; Elliott & Carnes, 2001; Everson et al., 1989; Kendall-Tackett et al., 1993; Wamser-Nanney & Sager, 2018). The different variables within this major cluster will now be discussed as they relate to one another. 87 9.1.3.1 Child Characteristics Within the major CPA MDS cluster, the gender of the child was found to be clustered with the relationship between the child and perpetrator. This correlation was positive and significant. Boys were found to be more closely related to perpetrators than girls. These two findings (i.e., gender being related to both severity of abuse and relationship between child and perpetrator) could be linked, such that boys were found to be more closely related to perpetrators. The more closely related the child is with the perpetrator, the more difficult it will be to disclose the abuse. This suggests that there must be an increased impetus for a child to report in situations where the victim might be a boy or more closely related to the perpetrator. Consequently, a higher severity of abuse may provide additional motivation for boys to disclose abuse carried out by a potentially trusted adult despite the negative repercussions. Gender was also clustered with blame. The direction of this relationship suggests that boys were blamed more often than girls. Similar to CSA, greater blame on boys in cases of CPA could be due to more traditional ideals regarding masculinity (Briggs, 2008; Scholes et al., 2014). Boys and men are typically seen as more capable of defending themselves (Salter et al., 2003). In some extreme cases, boys may even be seen as the aggressors, and so may receive more blame from disclosure recipients, as was directly noted within transcripts from the current study. Taken together, the association between the gender of the child and the other variables (i.e., the severity of abuse, the relation between the child and perpetrator, and blame) indicate that boys may be at particular risk when it comes to physical abuse. For example, boys will report a higher severity of abuse and are more likely to have pre-existing relationships with perpetrators. Finally, they are more likely to receive more blame for the abuse from disclosure recipients when they do decide to seek support. 88 9.1.3.2 Abuse Characteristics The other relationships within the CPA MDS model to consider are those between the severity of the abuse, the relation between the child and perpetrator, and blame. Reviewing the correlation matrix shows that the relation between the child and perpetrator decreased as the severity of the abuse increased. Hence, the more closely related the child and perpetrator, the less severe the physical abuse was. Although extrafamilial perpetrators commit abuse far less frequently, in the current study that abuse was more severe. Alternatively, non-offending caregivers more often carried out physical abuse during the commission of punishment. Both severity of abuse and relation to the perpetrator were positively correlated with blame. The close placement of these variables within the Euclidean space means that the more severe the abuse or closely related the child was to the perpetrator, the more likely non-offending caregivers were to blame the child. The relationship between the child and perpetrator may be the key to connecting all three variables within this cluster. First, the severity of abuse was negatively correlated to the relationship between the child and perpetrator. That is, more severe abuse would indicate less related perpetrators. Consequently, when non-offending caregivers are closely related to perpetrators, this may indicate a previous relationship of trust. Further, co-occurrence of domestic violence or bidirectional violence within the home may also be present when there is a close relationship between the victim and perpetrator. In this case, victims may be perceived to be partially at fault for continued physical abuse (Menaker & Franklin, 2017; Yamawaki et al., 2018). Victims might even be perceived to be more at fault when they respond negatively to abusive events, such as by yelling or hitting back (Capezza & Arriaga, 2008). Finally, denial and disbelief are also cited to be very common initial reactions to disclosures of child abuse, as they 89 serve to mentally insulate non-offending caregivers from their own feelings of guilt for letting the abuse take place (McElvaney et al., 2014; McElvaney & Nixon, 2020; Summit, 1993). Applying MDS procedures to our current data set allowed us to enhance our understanding of how child and abuse characteristics and non-offending caregiver responses relate to one another. For example, for both CSA and CPA, the disclosure recipient responses, belief of disclosure and reporting of the abuse were similarly related to the age of the child. In addition, the gender of the child was found to be highly related to the abuse type itself. For CSA, frequency was associated with the relationship between the child and the perpetrator. For CPA, the most prominent cluster that emerged across MDS procedures was the gender of the child, the relation between the child and perpetrator, and blame of the child. 9.2 Supportive Behaviours Each supportive behaviour was further examined to determine if specific child or abuse characteristics inhibited them. Supportive responses were found to be predicted by different variables. Overall, it was hypothesized that non-offending caregivers would be more supportive of children disclosing CSA over CPA. Results indicated that sexual abuse disclosure recipients were less likely to blame their child and to interrupt contact with the perpetrator when required. However, no significant differences were found between those who believed or reported the abuse across types. 9.2.1 Believing the Child There are inherently more signs of physical abuse than CSA, such as injury or witnesses (Rush et al., 2014). As a result, it was predicted that CPA disclosures would be more believable. Due to sample constraints, we were not able to examine this as there were not enough admissions of disbelief in CPA files to conduct our analyses. However, in reviewing the descriptive 90 statistics, we can see that 92% of the sample believed CPA disclosures, while a smaller 87% of CSA disclosures were believed. If it were possible to collect a larger sample (with more admissions of disbelief in CPA cases), differences in the prevalence of believing responses might become more pronounced. A lack of belief in disclosures of CSA could be in response to the absence of accompanying evidence (Rush et al., 2014). Several variables were prominent predictors of whether a non-offending caregiver would believe a child’s disclosure of CSA. Non-offending caregivers were less likely to believe older children’s disclosures. This finding is contrary to several studies which found no relationship between the age of the child and maternal support (Cyr et al., 2003; Wamser-Nanney & Sager, 2018), but aligns with the bulk of extant research (Feiring et al., 1998; Franke, 1989; Heriot, 1991; Salt et al., 1990). Older children’s disclosures may be seen as more credible as their narrative of the event(s) is more fluid and logical (Wamser-Nanney & Sager, 2018). However, the current results demonstrated that older children were believed less often. The multifaceted nature of support can further confuse findings as different forms of support can be given at different times and under different circumstances, as has become evident from this and previous studies. For example, Wasmer-Nanney and Sager (2018) found that older children received more emotional support from caregivers but also more blame and doubt, creating a mixed message regarding the nature and extent of support. When sexual abuse was more frequent, non-offending caregivers were less likely to believe their child’s disclosure. This finding is especially worrisome as children experiencing more frequent abuse may require intervention more so than children who might only endure a single abusive event. However, more frequent abuse may also be a consequence of the child’s failed attempts or decision not to disclose abuse. In previous research, the frequency of abuse has 91 been tied to the relationship between the child and the perpetrator (Wallis & Woodworth, 2020). Belief in disclosure was also found to be dependent on the relation between the child and perpetrator in cases of CSA. As noted earlier, strangers are unlikely to have consistent access to a child (Bergh, 2017). Alternatively, primary caregivers often have the most consistent access to the child creating multiple opportunities to re-offend. Wallis and Woodworth (2020) found that 80% of primary caregivers committed more than one offence, while 60% committed ten or more incidents of abuse. To summarize, responding to CSA disclosures with belief depended on the child’s age, the frequency of the abuse, and the relationship between the child and the perpetrator. 9.2.2 Blaming the Child The hypothesis that children disclosing CPA would experience more blame post-disclosure than those disclosing CSA was confirmed. Blame was found to fluctuate with the type of abuse disclosed. Caregivers expressed higher levels of blame when the child disclosed CPA. In the case of CSA, 3% of non-offending caregivers admitted to blaming their child for the abuse, whereas 15% blamed children disclosing CPA. Blame may be tied to what initiated the abuse. Physical abuse may occur during the commission of punishment (Belsky, 1980; Finkelhor et al., 2019; Kolko & Feiring, 2002). In the current study, many perpetrator narratives expressed that the abuse was a form of punishment for some wrongdoing. As such, the child might be thought to be at fault for initiating the physical punishment through their behaviour. While the abuse type itself mediated blame responses of non-offending caregivers, none of the child or abuse characteristics emerged as significant predictors. This suggests that abuse type is a stronger predictor of blame than other characteristics of the child or the abuse. 92 9.2.3 Interrupting Contact Interruption of contact between the child and perpetrator may not always be required. For example, if perpetrators do not have continuous contact with the child, there is no need to interrupt it. When interruption of contact was required, 66% of non-offending caregivers interrupted contact in CSA cases, while only 17% of non-offending caregivers interrupted contact in cases of CPA. This difference was statistically significant, and the prediction that non-offending caregivers would be more likely to interrupt contact in CPA cases was not supported. This original hypothesis was based on the finding from Study 1 that children were more closely related in CSA cases. While it was assumed that because of this closer relation, interruption of contact would occur more often, this was not found. Rather, interruption of contact may be a result of the overall higher severity of CSA experienced by children, as found in Study 1. Safety plans often include interruption of contact between the child and the perpetrator. Creating a safety plan and inhibiting contact can be seen as more crucial when abuse is more severe or does not occur during the commission of punishment. Above and beyond child or abuse characteristics, abuse type was found to accurately predict whether interruption of contact would occur. 9.2.4 Reporting Reporting abuse is a crucial step in help-seeking. Arguably, reporting may be the most important response for research to examine as it can prevent future abuse and lead to obtaining resources for the child. When discipline is combined with CPA, this can cause definitional issues surrounding labelling punishment as abuse (Belsky, 1980; Finkelhor et al., 2019; Kolko & Feiring, 2002). Definitional issues might also occur when the abuse is less severe, with the perception that less severe abuse typically warrants less intervention. The co-occurrence of 93 discipline can serve to blur the lines between abuse and punishment. Based on the abuse being initiated through punishment and the greater severity of CSA, it was hypothesized that non-offending caregivers would report CSA more often than CPA. This prediction was not supported as there were no differences in reporting rates across abuse types. Fifty-seven percent of non-offending caregivers who received a disclosure of CSA reported it, and 54% of CPA disclosures were reported. It is concerning that over 40% of non-offending caregivers did not report the abuse even when they had prior knowledge of it. Jurisdictional factors may apply here, where the caregivers know about the abuse but decide to seek alternate forms of resolution (Finkelhor et al., 2003). Additionally, material barriers may also apply. This includes the costs associated with reporting, such as time and financial resources. Alternatively, and more troubling non-offending caregivers may simply decide not to intervene. For CSA and CPA, different variables emerged as predictors of reporting. Reporting of CSA was predicted by the relation between the child and the perpetrator. If the perpetrator and child were more closely related, it was less likely that non-offending caregivers would make a report, a finding that was constrained to CSA. This association may be due to our finding from Study 1 that CSA perpetrators are more distantly related than CPA perpetrators. Alternatively, children may be more related in cases of CPA within this specific context, reported cases of child abuse. Perhaps the most insidious forms of CSA, such as when committed by a primary caregiver, are reported far less. Unfortunately, the current study was unable to assess cases where a report was never made. Regardless, abuse perpetrated by close relatives warrants particular attention in intervention efforts as they are less likely to seek formal support. In cases of CPA, the frequency of the abuse was the only prominent predictor of reporting. Increased frequency of abuse resulted in a lower likelihood of the non-offending 94 caregiver making a report. In this case, a greater frequency of abuse may be in response to a lack of ability or willingness to report the abuse on behalf of the child. As was already demonstrated, in some cases, caregivers may not report abuse at all (e.g., 47% of the current sample). 9.3 Conclusion Overall, the findings from Study 2 highlight the importance of considering child and abuse characteristics when understanding non-offending caregivers’ responses to disclosures of child abuse. Older children have a more difficult time securing support from non-offending caregivers. We emphasize the need for gender-specific considerations, as boys may face unique challenges in disclosing and receiving support for both CSA and CPA. The current analyses provide insight into factors that influence belief in disclosures, interruption of contact between the child and perpetrator, and reporting abuse across abuse types. Abuse type was found to be the strongest predictor of support, with more blame and less interruption of contact in cases of CPA. Relation between the child and perpetrator was the strongest predictor of reporting for CSA, while the frequency of abuse was the strongest predictor of reporting for CPA. These findings contribute to a deeper understanding of the complexities involved in non-offending caregivers’ responses to child abuse disclosures and have numerous implications. 95 CHAPTER 10: CONCLUSION 10.1 Implications Responses to disclosures of abuse have the potential to not only discontinue it but to elicit further disclosures and reports. Alternatively, if negative they may serve to inhibit the abuse from ever coming to light. Findings from Studies 1 and 2 can aid intervention and treatment efforts by identifying barriers for children disclosing and disclosure recipients in responding. Current findings add a missing element to the extant research on disclosure by comparing different abuse types. There were substantial differences across abuse type in disclosure relevant variables and patterns. This demonstrates that more general theories of disclosure do not always fit across abuse types, and there may be a need to apply unique theories to each. For example, theories relying on gendered explanations for behaviour would be helpful in supporting disclosures of CSA but not CPA. Creating theories that are parsimonious for each type of abuse has further implications for developing prevention and intervention strategies, as these theories can provide a framework for understanding behaviour and decision-making. Of note from Study 1 is that a prior disclosure was often required for a report to be made and that delays of disclosure were longer for children experiencing CSA. Caregivers should be encouraged to always create an environment supporting open communication with children, specifically regarding sexual health, consent, and boundaries. As prior disclosures are often required before reports can be made, this would increase the opportunity for children to disclose any abuse experienced or identify problematic adults. Non-offending caregivers should also intervene by ‘asking’ directly about abuse if they have suspicions. Alternatively, CPA did not always require a disclosure of abuse prior to a report. This may be due to the more overt signs of abuse, leading to its identification in the absence of disclosure. Public messaging regarding the 96 overt signs of physical abuse may be helpful in identifying it early on before more frequent incidents can occur. Further, it would be useful to better educate the wider community about different forms of abuse. For instance, information pamphlets could be provided at community or family focused agencies that provide useful guidelines on what constitutes abuse and appropriate parenting strategies. Further social media campaigns might also disseminate information regarding how to effectively communicate with children, how to recognize the signs of abuse early on, and provide resources to parents who may be struggling with parenting. Alternatively, lack of prior disclosures in cases of CPA could actually be due to a greater difficulty in disclosing. Interestingly, across both studies, several perpetrators indicated that CPA occurred while carrying out discipline. This suggests that physical abuse can occur during the commission of punishment. Punitive parenting styles and harsh discipline practices may be learned. Perpetrators often report past exposure to physical abuse (Bert et al., 2009; Dixon et al., 2005; Pears & Capaldi, 2001). This is known as the intergenerational transmission of violence. As high as 1/3 of the variance in predicting child abuse can be accounted for by maternal history of abuse (Haapasalo & Aaltonen, 1999). Furthermore, past abuse exposure resulted in decreased responsivity and an increased propensity for abusive behaviour (Bert et al., 2009). Caregivers with histories of abuse likely did not have the opportunity to observe consistent and fair parenting strategies (Pears & Capaldi, 2001). However, parenting programs show promise in improving the responsivity of and strategies used by caregivers (Vlahovicova et al., 2017). Contrary to previous research where peers were found to be the largest group to receive disclosures, Study 1 found non-offending caregivers to be the largest disclosure recipient group. However, non-offending caregivers may not necessarily be the largest disclosure recipient group, 97 they may simply be the largest participant group to actually report. As mentioned previously, peers often have a code of silence in which they may encourage each other to hide the abuse from safe adults (Flanagan & Stout, 2009; Syversten et al., 2009). Two important points can be gleaned from this. One, is that more education is required for youth regarding how they might both receive and respond to a friend if they should disclose abuse to them. The child receiving the disclosure should be encouraged to tell a safe adult and encourage the child making the disclosure to do the same. Alternatively, as non-offending caregivers are the most likely disclosure recipient group to report the abuse, they require special attention in intervention efforts. Concerningly, Study 2 found that just over half the sample of non-offending caregivers reported the abuse when they knew about it previously. This indicates that more needs to be done to bridge the gap between receiving a disclosure and reporting the abuse. Previous theories have noted common barriers for reporting to be histories of abuse, lack of trust in authorities, definitional issues surrounding what constitutes abuse, and jurisdictional issues in the resolution of abuse (Finkelhor et al., 2003; Xie & Baumert, 2019). These are the particular type of barriers that need to be addressed in the community. Social media campaigns and public messaging can target some of these barriers. For example, professionals may utilize various online contexts to distribute information defining abuse and its signs, providing more information on how to better respond to disclosures, and providing information on how and where to make a report. Building trust between authorities and the community is a much more complex task. However, a good starting point to improve community relations is working to create more positive interactions between police and community members (Lee et al., 2019). More favourable experiences, whether they are ultimately one time or ongoing, are associated with more positive views of the police. Others can shape their views of police vicariously through friends or family experiences, 98 or as seen in the media (Lorenz et al., 2021). Vicarious experiences with the police have been found to impact the decision of sexual assault survivors to report the crime (Lorenz et al., 2021). Positive interactions can be created by having police attend community events out of uniform and talk with attendees. They may also be fostered through their daily work by treating everyone with fairness and respect. When children were older, non-offending caregivers were less likely to believe their disclosures and subsequently report abuse. Public service announcements as seen on tv or in ads on the internet should address this barrier to disclosure. The autonomy that youth gain as they age may result in greater perceived culpability for their actions (Finkelhor et al., 2003). The public could be educated through publicly available online courses regarding typical decision-making and behaviour of children and youth during each developmental stage. Indeed, some parents may need additional reminders and education that teenagers are still vulnerable in a number of ways that would warrant their protection. Gender was heavily tied to several outcomes in the current study. Boys were proportionally less likely to report CSA, perhaps due to greater shame and stigma (Sgoi et al., 1982). Boys also received more unsupportive responses from non-offending caregivers, such as blame. More should be done in public health messaging to decrease the impact of the myths associated with male experiences of sexual abuse. Male survivor statements given in brief videos can be distributed online (i.e., YouTube, facebook, and pertinent child protection websites such as Child Advocacy Centres) or in television ads and may be promising in increasing disclosures as well as dispelling some of the negative attitudes regarding CSA. They could perhaps share their experience with telling others, give advice from a personal perspective, and guide others in similar situations. 99 Finally, responses to disclosures were found to be multifaceted and are impacted by distinct variables. Reporting CSA is best predicted by relation to perpetrator, but reporting CPA is best predicted by frequency of abuse. These findings might be utilized for more targeted intervention approaches. That is, depending on the supportive response we are trying to encourage we might address different barriers in intervention and treatment efforts. For example, children experiencing physical abuse also experienced more blame and less interruption of contact after disclosures. These unsupportive responses should be directly addressed in safety plans created by police and child protection agencies and in post-disclosure treatment of the child. Additionally, non-offending caregivers were less likely to report CSA when the perpetrator was closely related. Families may struggle with the decision to remain financially stable and together, or to report the abuse and risk having children and financial earners removed from the home. More can be done by the government and other community agencies to support these families and address concerns during investigations and afterward in the wake of these significant challenges and changes. 10.2 Limitations and Future Directions Findings from the current set of studies should be considered in light of several limitations. First and most importantly, the current sample consisted of a convenience sample of reported cases of child abuse. Generalizability is then an issue in the current study, as our cases involved those in which a report has been made and so a disclosure has occurred either informally or within a forensic interview. It is very likely that in our sample of reported cases of abuse, caregiver support may be higher than in a sample of unreported cases of abuse. However, child abuse is a largely underreported crime (Bottoms et al., 2016; Lev-Wiesel & First, 2018; London et al., 2005; Winters et al., 2020). Victims who make it to the disclosure or reporting 100 stage may be substantially different from those for whom their abuse is never found out (Connolly et al., 2015). Other studies have utilized telephone survey methods to collect data from the wider public. This method allows researchers to collect data from individuals who may not have disclosed until the time of the study. Future studies should also attempt to sample from a more general population. Comparisons can then be made between those who do and do not make it to the disclosure or reporting stage. A more inclusive sample would allow researchers to identify more substantial or accurate barriers to disclosure, especially for disclosure recipients. As a result of the convenient nature of this data, analyses were also restricted by the information available in RCMP case files. For example, two of the examined supportive behaviours, belief, and blame, could only be assessed through non-offending caregiver interview transcripts. As such, caregivers were not asked directly if they believed or blamed their child, and so it was unclear whether others may have brought it up in their narrative if they were explicitly asked. On that note, researchers for the current study were not able to secure multiple security clearances to obtain interrater reliability. While it is always preferrable to have two raters, this was not possible due to the incredibly sensitive and private nature of file information. Case files also come with limited information regarding non-victim individuals. Previous research has found that disclosure recipient factors also impact willingness to support children post-disclosure. For example, mothers’ substance use, and social isolation can predict whether they will respond supportively (Morrison & Clavenna-Valleroy, 1998). Future research should attempt to gather information regarding disclosure recipients to identify other variables that might impact their willingness to report on behalf of their child. Further, as ethnicity was derived based on observational methods, this variable was often inaccurate. Different cultures might endorse different sexual scripts and gender roles which have in the past been found to result in 101 differences in victim blaming attitudes (Ryan, 2011). Futures studies would benefit by including this factor in models. Supportive behaviours in caregivers have been traditionally difficult to study without bias (Lyon, 2007). Non-offending caregivers have much to lose by appearing unsupportive of their child, such as having them removed from the home. Some may give biased responses to interviews or underscore their true feelings to conform with answers they think will be desirable. In an attempt to avoid this issue of bias, the current study’s method of measuring support using cognitive, behavioural, and affective responses allowed us to examine caregiver responses indirectly. Nonetheless, future studies should still try to gather data from multiple sources, such as interviews and police reports. The current study was limited by small sample sizes, only including a final 59 CPA cases in Study 2. Larger sample sizes would make it more probable to meet the expected count for our logistic regressions, which would allow us to carry out other analyses. However, the samples were comparable to a large amount of research on disclosures that often conduct qualitative interviews with fewer participants (e.g., Alaggia, 2001; Hershkowitz et al., 2007; Mathews et al.,2016). It is hoped that moving forward more data from RCMP case files can be gathered, as well as additional files on different forms of abuse. Finally, the current study was not able to code any files containing neglect, although it is a commonly experienced form of abuse. Further, the current study did not examine co-occurring abuse. Children exposed to multiple types of victimization are at an even greater risk of experiencing immediate and lifetime prevalence of more severe trauma symptoms than those exposed to only one type (Finkelhor et al., 2007; Finkelhor et al., 2009). Evidence suggests that different forms of maltreatment on their own, or in combination, will result in very different 102 psychosocial consequences (Green et al., 2010; Hamby & Grych, 2013). In response to the possible differential impact of various forms of abuse and co-occurring abuse, factors that may exacerbate or improve outcomes should be explored. 10.3 Conclusion Theories have long been derived to explain CSA, but research on CPA is slower to catch up. The current set of studies provides a thorough examination of CSA and CPA disclosures and disclosure recipient responses. Sexual abuse and physical abuse were found to be substantially different along a number of child and abuse characteristics. The current set of studies emphasized the need to consider child and abuse characteristics, including age, gender, and relation to perpetrator, when understanding non-offending caregivers' responses. Older children had more difficulty receiving support from non-offending caregivers, and boys faced unique challenges in disclosing and seeking support for both CSA and CPA. Sexual abuse was reported to be more severe and frequently and involved a closer relation to perpetrators. These factors have also been shown in previous research to have a large impact on disclosures of abuse (Hershkowitz et al., 2007; Kogan, 2004; McElvaney, 2014; Paine & Hansen, 2002; Wallis & Woodworth, 2020). It is not surprising then that disclosures themselves were found to differ across abuse types. Disclosures were found to be more crucial to the reporting of CSA. Whereas reports were often brought forward in the absence of CPA disclosures. These findings have substantial implications for responses efforts. For CSA fostering an environment of trust and open communication between adults and children may increase opportunities for children to disclose. Alternatively, for CPA recognizing the signs and reporting abuse when witnessed may be more crucial targets for intervention efforts. 103 Most importantly, non-offending caregivers were found to be the largest disclosure recipient group indicating they are an important population to target in intervention efforts. Concerningly, almost half the current sample of non-offending caregivers did not report the abuse despite knowing about it previously. These findings indicate that more needs to be done to encourage supportive responses to disclosures such as through formal help-seeking. This could include reporting to the police or a child protection agency or seeking psychological support on behalf of the child. Further, features of the child impacted the ability and willingness of non-offending caregivers to respond effectively to disclosures, such as when the child was a boy or older. Study 2 found evidence for the differential impact of child and abuse characteristics on disclosure recipient responses. Abuse type itself was a strong predictor of whether a non-offending caregiver would blame the child or interrupt contact between the child and perpetrator. More unsupportive responses were given to children disclosing CPA. Reporting abuse was found to be impacted by unique factors per abuse type. Relation between the child and perpetrator was the strongest predictor of whether a report of CSA would be made, while frequency of abuse was the strongest predictor of whether a report of CPA would be made. Taken together these findings indicate that support is multifaceted and different supportive responses are impacted by distinct variables. Findings from the current set of studies contribute to a deeper understanding of the complexities involved in non-offending caregivers’ responses to child abuse disclosures. Specifically, while sharing some commonalities, CSA and CPA also hold substantial differences along child and abuse characteristics. As a result, disclosure itself was found to be significantly different in a number of important ways. Disclosure was more necessary for children 104 experiencing CSA yet was delayed longer, speaking to the nefarious and secretive nature of sexual abuse. Whereas CPA was often reported in the absence of a disclosure such as through evidence of injury or witnesses. It also occurred more often during the commission of punishment. In this case more support and education for caregivers surrounding parenting strategies might help to decrease instances of abuse. Children and youth may lack the ability to make a formal report of abuse themselves and rely on disclosure recipients for support and protection. However, not all disclosures will be received positively and even characteristics of the child like their age or gender can be determinants of support. Children received less supportive responses when disclosing CPA. Misperceptions surrounding culpability may have a large influence on willingness to respond effectively to disclosures of physical abuse. Considering the importance of supportive responses for positive outcomes across abuse type it is essential to explore why it may be given, and reasons it may be withheld. The current set of studies set out to thoroughly examine the interrelation between different child and abuse characteristics and disclosure responses. The ability of disclosure recipients to respond effectively seems to depend on a variety of social, emotional, and contextual factors that can be targeted within intervention and response efforts. Positive reception of abuse disclosures is paramount to intervention, and recovery of both the child impacted and the non-offending caregiver. 105 TABLES Table 1. CSA and CPA behaviours recorded. Scale Point CSA behaviours Count Scale Point CPA Behaviours Count 1 Sexually suggestive talk, hugs, or kissing 11 (3.9%) 1 Pushing or shaking 24 (13.1%) 2 Visual exposing of genitals (abuser or child), voyeurism or viewing pornography 7 (2.5%) 2 Excessive disciplinary spanking (limited to buttock, no injury or bruising) 15 (8.2%) 3 Fondling over child's clothes 45 (15.8%) 3 Pinched, bit, etc., causing limited surface injury 5 (2.7%) 4 Fondling under child's clothes 43 (15.1%) 4 Hitting and other minor assaults - hit, punched, kicked, or hit with object using an amount of force that could reasonably be expected to cause serious injury (e.g., minor bruises in a limited area, a small scratch, etc.) 100 (54.6%) 5 Simulated intercourse over clothes 4 (1.4%) 5 Burned to a limited extent including minor impulsive burns (e.g., a single impulsive cigarette burn) 0 6 Child masturbating abuser or involved in abuser's masturbation or simulated intercourse under clothes (penis between child's legs, no penetration) 23 (8.1%) 6 Threatened with a weapon (e.g., gun or knife) 7 (3.8%) 7 Oral contact - abuser to child's genitals 4 (1.4%) 7 Battery, beatings, and other major assaults - hit, punched, kicked, or hit with an object using a degree of force that could reasonably be expected to cause serious injury (e.g. severe or numerous bruises, swelling, bleeding, lost teeth, scars, broken bones) 20 (10.9%) 8 Oral contact - child to abuser's genitals 26 (9.2%) 8 Attacked with weapon (e.g., gun or knife) causing injury 4 (1.4%) 9 Digital or object penetration 30 (10.6%) 9 Burned extensively (e.g., more than a single burn or any burn with more than a small surface area) 0 10 Vaginal or anal intercourse (including unsuccessful attempts) 80 (28.2%) 10 Sadistic injury or torture 0 11 Paraphilic sex (e.g., urine, feces, bondage) or exploitation (e.g. prostitution) 4 (1.4%) 12 Ritual and satanic abuse or sexualized torture 1 (.4%) X Unknown 6 (2.1%) Total 284 183 106 Table 2. Frequency of relation to perpetrator. Relation CSA CPA 1 Stranger 27 3 2 Acquaintance, babysitter, neighbor 105 11 3 Teacher, minister, daycare worker, relative, or other involved adult living out of the home 42 3 4 In-home sibling or step-sibling 15 21 5 In-home adult, except parent/stepparent 30 13 6 Noncustodial 22 27 7 In-home primary caretaker (e.g., custodial parent, stepparent or guardian) 38 99 X Unknown 5 6 Total 284 183 107 Table 3. Disclosure recipients across abuse type. Disclosure Recipient CSA CPA Peer (Friend/Boyfriend/Girlfriend/Husband) 46 11 School Employee (school counsellor, administrator, teacher, vice principal, principal, etc.) 22 4 Other professional (social worker, nurse, therapist, paster) 26 17 Child relatives (cousin, sister, brother) 14 0 Adult relative (other than caregiver, aunt, uncle, grandma) 13 4 Non-offending caregiver (father = 15, 3, mother = 69, 32 94 38 No prior disclosure 62 118 Unknown 7 2 Total 284 194 Note. In some cases, a disclosure was made to multiple recipients before a report was made. 108 Table 4. Prevalence of Non-offending Caregiver Responses. CSA CPA CSA CPA CSA CPA Response Supportive Supportive Unsupportive Unsupportive NA/Not required NA/Not required Believed the Child 165 (78%) 23 (39%) 25 (12%) 2 (3%) 21 (10%) 34 (58%) Blamed the Child 153 (73%) 17 (29%) 5 (2%) 4 (7%) 53 (25%) 38 (64%) Interrupted Contact 52 (25%) 6 (10%) 27 (13%) 33 (56%) 132 (63%) 20 (34%) Reported Abuse 100 (47%) 29 (49%) 84 (40%) 29 (49%) 27 (13%) 1 (2%) Had Knowledge of Abuse = Total 211 59 211 59 211 59 109 Table 5. Spearman's rho correlation matrix for all variables of interest. 1 2 3 4 5 6 7 8 9 10 1 Gender - 2 Age -.164** - 3 Severity -0.053 -0.072 - 4 Frequency 0.081 -.276** .169** - 5 Relation .209** -.194** -0.059 .306** - 6 Abuse Type .444** 0.067 -.214** -0.026 .420** - 7 Believe 0.102 -0.040 -0.071 -.194** -.201** 0.093 - 8 Blame 0.019 0.011 0.055 0.069 .130* 0.085 -.181** - 9 Contact Interrupted -0.095 -.142* 0.009 0.024 -0.076 -.142* 0.049 -0.017 - 10 Report -0.094 -0.013 -0.085 -0.102 -.149* 0.016 .248** -0.117 .138* - Note. **. Correlation is significant at the 0.01 level (2-tailed). *. Correlation is significant at the 0.05 level (2-tailed). 110 Table 6. Spearman’s rho correlation matrix for CSA variables and non-offending caregiver responses. 1 2 3 4 5 6 7 8 9 1 Gender - 2 Age -.216** - 3 Severity -0.001 -0.024 - 4 Frequency 0.089 -.305** 0.114 - 5 Relation -0.033 -.305** 0.070 .368** - 6 Believe 0.111 -0.093 -0.027 -.209** -.280** - 7 Blame -0.057 0.105 0.050 0.035 0.099 -.289** - 8 Contact Interrupted -0.062 -.144* -0.032 0.045 -0.022 0.065 0.025 - 9 Report -0.065 -0.036 -0.093 -0.018 -.172* .271** -0.069 .149* - Note. **. Correlation is significant at the 0.01 level (2-tailed). *. Correlation is significant at the 0.05 level (2-tailed). 111 Table 7. Spearman’s rho correlation matrix for CPA variables and non-offending caregiver responses. 1 2 3 4 5 6 7 8 9 1 Gender - 2 Age -0.229 - 3 Severity 0.185 -0.199 - 4 Frequency 0.152 -0.119 .359* - 5 Relation .306* 0.021 -0.041 0.265 - 6 Believe -0.110 0.225 -0.192 -0.097 - 7 Blame 0.037 -0.218 0.134 0.183 0.175 0.032 - 8 Contact Interrupted 0.049 -0.087 0.045 -0.190 0.139 0.046 -0.074 - 9 Report -0.236 0.056 -0.024 -.500** -0.189 0.136 -0.238 0.108 - Note. **. Correlation is significant at the 0.01 level (2-tailed). *. Correlation is significant at the 0.05 level (2-tailed). 112 Table 8. Logistic Regression Predicting the Likelihood of a Non-offending Caregivers Believing the Child a Disclosure of CSA. 95% CI for Odds Ratio B SE Wald df p Odds Ratio Lower Upper Gender -18.567 6705.807 0.000 1 0.998 0.000 0.000 Age of Child -1.222 0.472 6.687 1 0.010 0.295 0.117 0.744 Relation to Perpetrator -1.381 0.425 10.560 1 0.001 0.251 0.109 0.578 Severity -0.444 0.622 0.508 1 0.476 0.642 0.190 2.172 Frequency -0.894 0.385 5.405 1 0.020 0.409 0.192 0.869 Note. Gender is for boys compared to girls. 113 Table 9. Logistic Regression Predicting the Likelihood of a Non-offending Caregivers Reporting the Abuse after a Disclosure of CSA. 95% CI for Odds Ratio B SE Wald df p Odds Ratio Lower Upper Gender -0.768 0.464 2.738 1 0.098 0.464 0.187 1.152 Age of Child -0.171 0.173 0.979 1 0.323 0.843 0.601 1.182 Relation to Perpetrator -0.489 0.173 7.974 1 0.005 0.613 0.437 0.861 Severity -0.324 0.256 1.603 1 0.205 0.723 0.438 1.194 Frequency 0.186 0.191 0.957 1 0.328 1.205 0.829 1.750 Note. Gender is for boys compared to girls. 1 = Girl, 2 = Boy. 114 Table 10. Logistic Regression Predicting the Likelihood of a Non-offending Caregivers Reporting the Abuse after a Disclosure of CPA. 95% CI for Odds Ratio B SE Wald df p Odds Ratio Lower Upper Gender -0.663 0.868 0.585 1 0.445 0.515 0.094 2.822 Age of Child -0.439 0.483 0.827 1 0.363 0.645 0.250 1.661 Relation to Perpetrator 0.210 0.629 0.111 1 0.738 1.234 0.359 4.236 Severity 0.965 0.554 3.037 1 0.081 2.624 0.887 7.766 Frequency -2.582 0.860 9.015 1 0.003 0.076 0.014 0.408 Note. Gender is for boys compared to girls. 1 = Girl, 2 = Boy. 115 FIGURES Figure 1. Shepards Plots displaying the fit of the possible Multidimensional Scaling Models. Note. K = number of dimensions. 116 Figure 2. Multidimensional Scaling Model of Child and Abuse Characteristics, and Non-offending Caregiver Responses Note. Child characteristics are noted in red, abuse characteristics are in blue, and non-offending caregiver responses are in green. 117 Figure 3. Multidimensional Scaling Model of Child and Abuse Characteristics, and Non-offending Caregiver Responses for CSA Note. Child characteristics are noted in red, abuse characteristics are in blue, and non-offending caregiver responses are in green. 118 Figure 4. Multidimensional Scaling Model of Child and Abuse Characteristics, and Non-offending Caregiver Responses for CPA Note. Child characteristics are noted in red, abuse characteristics are in blue, and non-offending caregiver responses are in green. 119 Figure 5. Receiver Operating Characteristic Curve displaying the Impact of Child and Abuse Characteristics on Reporting CSA 120 Figure 6. Receiver Operating Characteristic Curve displaying the Impact of Child and Abuse Characteristics on Reporting CPA 121 REFERENCES Anderson, G. D. (2016). 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Child at Risk Age: Age: Gender: Ethnicity: Gender: Ethnicity: Psychological/Medical: Psychological/Medical: Behavioural Concerns: Behavioural Concerns: Relation to the accused: Perpetrator Information Perpetrator Age: Previous Criminal Convictions: Gender: Ethnicity: History of drug use: Age, first offence: Age, most recent: Family Archetype (optional) Living Situation: Family, Foster home... How long: Family History: divorce/death 149 # of Siblings: Ages: Gender: Offended Against: Y/N Family Support - non-offending caregiver Knowledge of abuse: Y/N Did caregiver report abuse: Y/N Was contact interrupted: Y/N Did caregiver believe child: Y/N Qualitative information from interviews: caregiver feelings, beliefs about the future Investigation Characteristics Sibling Interviews: Y/N Forensic Medical Exam: Y/N Who conducted it: Findings: Multidisciplinary Team: Y/N Members of team: Other Evidence available: MDT case review: Y/N Who was present: Disclosure Patterns Setting of interview: detachment, school, etc. Number of Interviews: Length of interviews: hours and minutes Denial of Abuse: Y/N Number of Interviews till disclosure: How long into interview: Full Disclosure: Y/N Recantation present: Y/N After initial disclosure: Next Interview More detail added: Y/N Conflicting details: Y/N More perpetrators revealed: Y/N Investigative outcomes Arrest: Y/N Conviction: Charges laid: Reasons for no charges: 150 Children forcefully removed from home: Y/N Mental Health referals: Victim Support and Advocacy: Court Preparation: 151 Appendix B – CSA Coding Form Sexual Abuse Behaviors x Unknown 1 Sexually suggestive talk, hugs, or kissing 2 Visual exposing of genitals (abuser or child), voyeurism or viewing pornography 3 Fondling over child's clothes 4 Fondling under child's clothes 5 Simulated intercourse over clothes 6 Child masturbating abuser or involved in abuser's masturbation or simulated intercourse under clothes (penis between child's legs, no penetration) 7 Oral contact - abuser to child's genitals 8 Oral contact - child to abuser's genitals 9 Digital or object penetration 10 Vaginal or anal intercourse (including unsuccessful attempts) 11 Paraphilic sex (e.g., urine, feces, bondage) or exploitation (e.g. prostitution) 12 Ritual and satanic abuse or sexualized torture Total Duration of Abuse X Unknown Approximate age at onset Approximate age at last occurrence Duration of Abuse Number of MOST SEVERLY RATED Incidents X Unknown Approximate number of incidents Number of TOTAL Incidents (all types) X Unknown Approximate number of incidents Reaction of Abuser(s) X Unknown Admits and accepts responsibility Admits, but does not take responsibility Does not admit Denies and blames others (e.g., child's nonoffending parent) Denies and blames victim Severity of Reaction Use of Force or Coercing X Unknown 1 Seduction or use of reward, affection, privilege, or other similar inducements 152 2 Status or role differential (e.g., authority figures) 3 Threat that affection, privilege, or other positives will be taken away 4 Threat of physical punishment 5 Use of force (holding down, prying legs apart, etc.) 6 Threats of death (victims or others) 7 Use of assaultive force (hitting, beating, etc.) 9 Use of deadly weapon Total Coercion to Gain Secrecy X Unknown 1 No mention of secrecy 2 Unelaborated statement to "not tell" without implicit or explicit threat 3 Threats involving loss of affection, mild consequences, or implicit demands for secrecy (getting in trouble, others won’t understand, "special secret," etc.) 4 Threats involving serious consequences (family breakup, jail, emotional damage to others, foster care, etc.) 5 Threat of violence (victim or others) 6 Threat of death (victim or others) Level of Coercion Role of Abuser (s) in Child's Life X Unknown 1 Stranger 2 Acquaintance, babysitter, neighbor 3 Teacher, minister, daycare worker, relative, or other involved adult living out of the home 4 In-home sibling or step-sibling 5 In-home adult, except parent/stepparent 6 Noncustodial 7 In-home primary caretaker (e.g., custodial parent, stepparent or guardian) Victim Perpetrator Relationship 153 Appendix C – CPA Coding Form Physical Abuse Behaviors X Unknown 1 Pushing or shaking 2 Excessive disciplinary spanking (limited to buttock, no injury or bruising) 3 Pinched, bit, etc., causing limited surface injury 4 Hitting and other minor assaults - hit, punched, kicked, or hit with object using an amount of force that could reasonably be expected to cause serious injury (e.g., minor bruises in a limited area, a small scratch, etc.) 5 Burned to a limited extent including minor impulsive burns (e.g., a single impulsive cigarette burn) 6 Threatened with a weapon (e.g., gun or knife) 7 Battery, beatings, and other major assaults - hit, punched, kicked, or hit with an object using a degree of force that could reasonably be expected to cause serious injury (e.g. severe or numerous bruises, swelling, bleeding, lost teeth, scars, broken bones) 8 Attacked with weapon (e.g., gun or knife) causing injury 9 Burned extensively (e.g., more than a single burn or any burn with more than a small surface area) 10 Sadistic injury or torture Total Duration of Abuse X Unknown Approximate age at onset Approximate age at last occurrence Number of MOST SEVERLY RATED Injuries X Unknown Approximate number of incidents Number of TOTAL Incidents (all types) 154 X Unknown Approximate number of incidents Reaction of Abuser X Unknown 1 Admits and accepts responsibility 2 Admits, but does not take responsibility 3 Does not admit 4 Denies and blames others (e.g., child's nonoffending parent) 5 Denies and blames victim Total Coercion to Gain Secrecy X Unknown 1 No mention of secrecy 2 Unelaborated statement to "not tell" without implicit or explicit threat 3 Threats involving loss of affection, mild consequences, or implicit demands for secrecy (getting in trouble, others won't understand, "special secret," etc.) 4 Threats involving serious consequences (family breakup, jail, emotional damage to others, foster care, etc.) 5 Threat of violence (victim or others) 6 Threat of death (victim or others) Total Role of Abuser(s) in Child's Life X Unknown 1 Stranger 2 Acquaintance, babysitter, neighbor 3 Teacher, minister, daycare worker, relative, or other involved adult living out of the home 4 In-home sibling or step-sibling 155 5 In-home adult, except parent or stepparent 6 Noncustodial parent 7 In-home primary caretaker (e.g., custodial parent. Stepparent, or guardian) Victim perpetrator Relationship 156 Appendix D – MDS R Code ####### MDS Dissertation setwd("/Users/cassi/OneDrive/Desktop/Results Dissertation") imageDirectory<-"/Users/cassi/OneDrive/Desktop/Results Dissertation" ##install.packages("smacof") ##install.packages("MASS") library(smacof); library(MASS) library(haven) library(ggplot2) install.packages("ggrepel") library(ggrepel) install.packages("ggtext") library(ggtext) install.packages("showtext") library(showtext) library(ggplot2) font_add_google("Fira Sans") ##Diss correlation matrix read.csv("Correlation Matrix MDS Final.csv") abuseresponses <- read_spss("Correlation Matrix MDS Final.sav") head(abuseresponses) ##Converting correlation matrix to distance matrix Dismatrix<-sim2diss(abuseresponses, method = "corr", to.dist = TRUE) Dismatrix # Model Comparisons ------------------------------------------------------- mds_mods <- list() mod_params <- expand.grid( ndim = 1:3, type = c("ratio", "interval", "ordinal", "mspline"), stringsAsFactors = FALSE ) for (i in 1:nrow(mod_params)) { mds_modsi <- smacof::mds(d, ndim = mod_params$ndimi, type = mod_params$typei ) } shepard_dta <- lapply(mds_mods, \(x) data.frame( 157 type = factor( x$type, levels = c("ratio", "interval", "ordinal", "mspline") ), ndim = x$ndim, stress = round(x$stress, 2), x1 = as.vector(x$delta), y1 = as.vector(x$confdist), x2 = as.vector(x$delta)[x$iord], y2 = as.vector(x$dhat[x$iord]) ) ) |> do.call(what = "rbind") stress_dta <- lapply(mds_mods, \(x) data.frame( type = factor( x$type, levels = c("ratio", "interval", "ordinal", "mspline") ), ndim = x$ndim, x = 1.1, y = 1.5, stress = x$stress ) ) |> do.call(what = "rbind") ggplot(shepard_dta) + facet_grid(rows = vars(ndim), cols = vars(type), labeller = labeller( type = c("ratio" = "Ratio", "interval" = "Interval", "ordinal" = "Ordinal", "mspline" = "Spline" ), ndim = c("1" = "*k* = 1", "2" = "*k* = 2", "3" = "*k* = 3") ) ) + geom_point(aes(x1, y1), colour = "#f2685b") + geom_path(aes(x2, y2)) + geom_label( mapping = aes(x = 1.65, y = -.15, label = paste0("Stress = ", sprintf("%.2f", stress)) ), data = stress_dta, hjust = 1, label.r = unit(0, "lines"), size = 3, label.size = 0, family = "Fira Sans", fill = "grey92" 158 ) + labs(x = "Dissimilarities", y = "Configuration Distances") + theme_minimal(base_family = "Fira Sans") + theme( strip.background.x = element_rect(fill = "grey92", colour = "grey92"), strip.text = element_markdown(face = "bold"), strip.text.y = element_markdown(angle = 0), panel.border = element_rect(colour = "grey92", fill = NA), aspect.ratio = 1 ) ##Running the MDS d <- dist(Dismatrix) MDS <- cmdscale(d,eig=TRUE, k=2) isoMDS(d, y = cmdscale(d, 2), k = 2, maxit = 50, trace = TRUE, tol = 1e-3, p = 2) MDS ##ggplot plot dta <- data.frame(x = x, y = y, label = colnames(abuseresponses), colour = c("blue", "blue", rep("red", 3), rep("green", 5))) ggplot(aes(x = x , y = y), data = dta) + theme_classic() + geom_point(aes(x = x, y = y, colour = colour), data = dta, size = 2) + geom_text(aes(x = x - .03, y = y - .03, label = label, colour = colour), data = dta, size = 3) + xlab("Dim 1") + ylab("Dim 2") + theme(legend.position = "none") ###creating stress values 1d.output<-isoMDS(Dismatrix, k=1) ####New Figure 1###### mod <- mds(d, ndim = 2, type = "ordinal") dta <- data.frame( var = rownames(mod$conf), D1 = mod$conf[, 1], D2 = mod$conf[, 2], type = c( rep("Child Characteristics", 2), rep("Abuse Characteristics", 3), rep("Caregiver Responses", 5) ) ) dta$type <- factor(dta$type, 159 levels = c( "Child Characteristics", "Abuse Characteristics", "Caregiver Responses" ) ) ggplot(dta, aes(D1, D2, group = type, label = var)) + # geom_text() + geom_hline(yintercept = 0, colour = "grey85", linewidth = 1) + geom_vline(xintercept = 0, colour = "grey85", linewidth = 1) + geom_point(aes(shape = type, colour = type), size = 2) + geom_text_repel(family = "") + labs( x = "Dim 1", y = "Dim 2", colour = NULL, shape = NULL ) + scale_colour_manual(values = c("#f2685b", "#43a29c", "#da8332")) + theme_minimal(base_family = "Fira Sans") + theme( plot.title.position = "plot", plot.title = element_text(face = "bold"), legend.position = "bottom", aspect.ratio = 1 ) ggsave("mdsplot.png", width = 4, height = 4, dpi = 320) dta <- data.frame(var = rownames(mod2), D1 = mod2[, 1], D2 = mod2[, 2]) ggplot(dta, aes(D1, D2, label = var)) + geom_hline(yintercept = 0, colour = "grey85", linewidth = 1) + geom_vline(xintercept = 0, colour = "grey85", linewidth = 1) + geom_point(colour = "#f2685b", size = 2) + geom_text_repel(family = "Fira Sans") + labs( x = "Dim 1", y = "Dim 2" ) + theme_minimal(base_family = "Fira Sans") + theme( plot.title.position = "plot", plot.title = element_text(face = "bold"), legend.position = "bottom", aspect.ratio = 1 ) #######CSA ONly########## ##Diss correlation matrix 160 read.csv("CSA Correlation Matrix.csv") abuseresponsesCSA <- read.csv("CSA Correlation Matrix.csv") head(abuseresponsesCSA) ##Converting correlation matrix to distance matrix DismatrixCSA<-sim2diss(abuseresponsesCSA, method = "corr", to.dist = TRUE) DismatrixCSA ##Running the MDS d <- dist(DismatrixCSA) MDSCSA <- cmdscale(d,eig=TRUE, k=2) isoMDS(d, y = cmdscale(d, 2), k = 2, maxit = 50, trace = TRUE, tol = 1e-3, p = 2) MDSCSA ## Creating Figure code that did work x <- round(MDSCSA$points[,1],2) y <- round(MDSCSA$points[,2],2) plot(x, y, type="n") text(x, y, labels =(DismatrixCSA), cex=.8) ##ggplot plot dta <- data.frame(x = x, y = y, label = colnames(abuseresponsesCSA), colour = c("blue", "blue", rep("red", 3), rep("green", 4))) ggplot(aes(x = x , y = y), data = dta) + theme_classic() + geom_point(aes(x = x, y = y, colour = colour), data = dta, size = 2) + geom_text(aes(x = x - .03, y = y - .03, label = label, colour = colour), data = dta, size = 3) + xlab("Dim 1") + ylab("Dim 2") + theme(legend.position = "none") #####New Figure 2#### mod <- mds(d, ndim = 2, type = "ordinal") dta <- data.frame( var = rownames(mod$conf), D1 = mod$conf[, 1], D2 = mod$conf[, 2], type = c( rep("Child Characteristics", 2), rep("Abuse Characteristics", 3), rep("Caregiver Responses", 4) ) 161 ) dta$type <- factor(dta$type, levels = c( "Child Characteristics", "Abuse Characteristics", "Caregiver Responses" ) ) ggplot(dta, aes(D1, D2, group = type, label = var)) + # geom_text() + geom_hline(yintercept = 0, colour = "grey85", linewidth = 1) + geom_vline(xintercept = 0, colour = "grey85", linewidth = 1) + geom_point(aes(shape = type, colour = type), size = 2) + geom_text_repel(family = "") + labs( x = "Dim 1", y = "Dim 2", colour = NULL, shape = NULL ) + scale_colour_manual(values = c("#f2685b", "#43a29c", "#da8332")) + theme_minimal(base_family = "Fira Sans") + theme( plot.title.position = "plot", plot.title = element_text(face = "bold"), legend.position = "bottom", aspect.ratio = 1 ) ggsave("mdsplot.png", width = 4, height = 4, dpi = 320) #######CPA ONly########## ##Diss correlation matrix read.csv("CPA Correlation Matrix.csv") abuseresponsesCPA <- read.csv("CPA Correlation Matrix.csv") head(abuseresponsesCPA) ##Converting correlation matrix to distance matrix DismatrixCPA<-sim2diss(abuseresponsesCPA, method = "corr", to.dist = TRUE) DismatrixCPA ##Running the MDS d <- dist(DismatrixCPA) MDSCPA <- cmdscale(d,eig=TRUE, k=2) isoMDS(d, y = cmdscale(d, 2), k = 2, maxit = 50, trace = TRUE, tol = 1e-3, p = 2) MDSCPA ## Creating Figure code that did work 162 x <- round(MDSCPA$points[,1],2) y <- round(MDSCPA$points[,2],2) plot(x, y, type="n") text(x, y, labels =(DismatrixCPA), cex=.8) ##ggplot plot dta <- data.frame(x = x, y = y, label = colnames(abuseresponsesCPA), colour = c("blue", "blue", rep("red", 3), rep("green", 4))) ggplot(aes(x = x , y = y), data = dta) + theme_classic() + geom_point(aes(x = x, y = y, colour = colour), data = dta, size = 2) + geom_text(aes(x = x - .03, y = y - .03, label = label, colour = colour), data = dta, size = 3) + xlab("Dim 1") + ylab("Dim 2") + theme(legend.position = "none") #######New Figure 3###### mod <- mds(d, ndim = 2, type = "ordinal") dta <- data.frame( var = rownames(mod$conf), D1 = mod$conf[, 1], D2 = mod$conf[, 2], type = c( rep("Child Characteristics", 2), rep("Abuse Characteristics", 3), rep("Caregiver Responses", 4) ) ) dta$type <- factor(dta$type, levels = c( "Child Characteristics", "Abuse Characteristics", "Caregiver Responses" ) ) ggplot(dta, aes(D1, D2, group = type, label = var)) + # geom_text() + geom_hline(yintercept = 0, colour = "grey85", linewidth = 1) + geom_vline(xintercept = 0, colour = "grey85", linewidth = 1) + geom_point(aes(shape = type, colour = type), size = 2) + geom_text_repel(family = "") + labs( x = "Dim 1", y = "Dim 2", colour = NULL, shape = NULL 163 ) + scale_colour_manual(values = c("#f2685b", "#43a29c", "#da8332")) + theme_minimal(base_family = "Fira Sans") + theme( plot.title.position = "plot", plot.title = element_text(face = "bold"), legend.position = "bottom", aspect.ratio = 1 )
Thesis/Dissertation
eng
Psychology
Vancouver : University of British Columbia Library
Attribution-NonCommercial-NoDerivatives 4.0 International
Graduate
Woodworth, Michael T.
"You can tell me anything" : the role of caregivers in obtaining and maintaining support for children after receiving a disclosure of physical or sexual abuse
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