## Exhibit B EFTA00088888 Review Manuscript # Facilitators and Barriers to Child Sexual Abuse (CSA) Disclosures: A Research Update (2000-2016) TRAUMA, VIOLENCE, & ABUSE 2019, Vol. 20(2) 260-283 © The Author(s) 2017 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/1524838017697312 journals.sagepub.com/home/tva SAGE Ramona Alaggia¹, Delphine Collin-Vézina², and Rusan Lateef¹ ## Abstract Identifying and understanding factors that promote or inhibit child sexual abuse (CSA) disclosures has the potential to facilitate earlier disclosures, assist survivors to receive services without delay, and prevent further sexual victimization. Timely access to therapeutic services can mitigate risk to the mental health of survivors of all ages. This review of the research focuses on CSA disclosures with children, youth, and adults across the life course. Using Kiteley and Stogdon’s literature review framework, 33 studies since 2000 were identified and analyzed to extrapolate the most convincing findings to be considered for practice and future research. The centering question asked: What is the state of CSA disclosure research and what can be learned to apply to practice and future research? Using Braun and Clarke’s guidelines for thematic analysis, five themes emerged: (1) Disclosure is an iterative, interactive process rather than a discrete event best done within a relational context; (2) contemporary disclosure models reflect a social–ecological, person-in-environment orientation for understanding the complex interplay of individual, familial, contextual, and cultural factors involved in CSA disclosure; (3) age and gender significantly influence disclosure; (4) there is a lack of a life-course perspective; and (5) barriers to disclosure continue to outweigh facilitators. Although solid strides have been made in understanding CSA disclosures, the current state of knowledge does not fully capture a cohesive picture of disclosure processes and pathways over the life course. More research is needed on environmental, contextual, and cultural factors. Barriers continue to be identified more frequently than facilitators, although dialogical forums are emerging as important facilitators of CSA disclosure. Implications for practice in facilitating CSA disclosures are discussed with recommendations for future research. ## Keywords ## Introduction sexual abuse, child abuse, cultural contexts Timely access to supportive and therapeutic resources for child sexual abuse (CSA) survivors can mitigate risk to the health and mental health well-being of children, youth, and adults. Identifying and understanding factors that promote or inhibit CSA disclosures have the potential to facilitate earlier disclosures, assist survivors to receive services without delay, and potentially prevent further sexual victimization. Increased knowledge on both the factors and the processes involved in CSA disclosures is timely when research continues to show high rates of delayed disclosures (Collin-Vézina, Sablonni, Palmer, & Milne, 2015; Crisma, Bascelli, Paci, & Romito, 2004; Easton, 2013; Goodman-Brown, Edelstein, Goodman, Jones, & Gordon, 2003; Hershkowitz, Lanes, & Lamb; 2007; Jonzon & Lindblad, 2004; McElvaney, 2015; Smith et al., 2000). Incidence studies in the United States and Canada report decreasing CSA rates (Fallon et al., 2015; Finkelhor, Shattuck, Turner, & Hamby, 2014; Trocmé et al., 2005, 2008), while at the same time global trends from systematic reviews and meta-analyses have found concerning rates of CSA, with averages of 18–20% for females and of 8–10% for males (Pereda, Guilera, Forms, & Gómez-Benito, 2009). The highest rates found for girls is in Australia (21.5%) and for boys in Africa (19.3%), with the lowest rates for both girls (11.3%) and boys (4.1%) reported in Asia (Stoltenborgh, van IJzendoorn, Euser, & Bakermans-Kranenburg, 2011). These findings point to the incongruence between the low number of official reports of ¹ Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada $ ^{2} $Centre for Research on Children and Families, School of Social Work, McGill University, Montreal, Qubec, Canada Corresponding Author: Ramona Alaggia, Factor-Inwentash Chair in Children’s Mental Health, Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St. West, Toronto, Ontario, Canada M4K1W1. Email: ramona.alaggia@utoronto.ca EFTA00088889 Alaggia et al. 261 CSA to authorities and the high rates reported in prevalence studies. For example, a meta-analysis conducted by Stoltenborgh, van IJzendoorn, Euser, and Bakermans-Kranenburg (2011) combining estimations of CSA in 217 studies published between 1980 and 2008 revealed rates of CSA to be more than 30 times greater in studies relying on self-reports (127 in 1,000) than in official report inquiries, such as those based on data from child protection services and the police (4 in 1,000) (Jillian, Cotter, & Perreault, 2014; Statistics Canada 2013). In other words, while 1 out of 8 people retrospectively report having experienced CSA, official incidence estimates indicate only 1 per 250 children. In a survey of Swiss child services, Maier, Mohler-Kuo, Landholt, Schnyder, and Jud (2013) further found 2.68 cases per 1,000 of CSA disclosures, while in a recent comprehensive review McElvaney (2015) details the high prevalence of delayed, partial, and nondisclosures in childhood indicating a persistent trend toward withholding CSA disclosure. It is our view that incidence statistics are likely an underestimation of CSA disclosures, and this drives the rationale for the current review. Given the persistence of delayed disclosures with research showing a large number of survivors only disclosing in adulthood (Collin-Vézina et al., 2015; Easton, 2013; Hunter, 2011; McElvaney, 2015; Smith et al., 2000), these issues should be a concern for practitioners, policy makers, and the general public (McElvaney, 2015). The longer disclosures are delayed, the longer individuals potentially live with serious negative effects and mental health problems such as depression, anxiety, trauma disorders, and addictions, without receiving necessary treatment. This also increases the likelihood of more victims falling prey to undetected offenders. Learning more about CSA disclosure factors and processes to help advance our knowledge base may help professionals to facilitate earlier disclosures. Previous literature reviews examining factors influencing CSA disclosure have served the field well but are no longer current. Important contributions on CSA disclosures include Paine and Hansen’s (2002) original review covering the literature largely from the premillennium era, followed by London, Bruck, Ceci, and Shuman’s (2005) subsequent review, which may not have captured publications affected by “lag to print” delays so common in peer-reviewed journals. These reviews are now dated and therefore do not take into account the plethora of research that has been accumulated over the past 15 years. Other recent reviews exist but with distinct contributions on the dialogical relational processes of disclosure (Reitsema & Grietens, 2015), CSA disclosures in adulthood (Tener & Murphy, 2015), and delayed disclosures in childhood (McElvaney, 2015). This literature review differs by focusing on CSA disclosures in children, youth, and adults from childhood and into adulthood—over the life course. ## Method Kiteley and Stogdon’s (2014) systematic review framework was utilized to establish what has been investigated in CSA disclosure research, through various mixed methods, to highlight the most convincing findings that should be considered for future research, practice, and program planning. This review centered on the question: What is the state of CSA disclosure research and what can be learned to apply to future research and practice? By way of clarification, the term systematic refers to a methodologically sound strategy for searching literature on studies for knowledge construction, in this case the CSA disclosure literature, rather than intervention studies. The years spanned for searching the literature were 2000–2016, building on previous reviews without a great deal of overlap. Retrieval of relevant research was done by searching international electronic databases: PsycINFO, PsycARTICLES, Educational Resources Information Center, Canadian Research Index, International Bibliography of the Social Sciences, Published International Literature on Traumatic Stress, Sociological Abstracts, Social Service Abstracts, and Applied Social Science Index and Abstracts. This review searched peer-reviewed studies. A search of the gray literature (unpublished literature such as internal agency documents, government reports, etc.) was beyond the scope of this review because unpublished studies are not subjected to a peer-review process. Keyword search terms used were child sexual abuse, childhood sexual abuse, disclosure, and telling. A search of the 9 databases produced 322 peer-reviewed articles. Selected search terms yielded 200 English publications, 1 French study, and 1 Portuguese review. The search was further refined by excluding studies focusing on forensic investigations, as these studies constitute a specialized legal focus on interview approaches and techniques. As well, papers that focused exclusively on rates and responses to CSA disclosure were excluded, as these are substantial areas unto themselves, exceeding the aims of the review question. Review articles were also excluded. Once the exclusion criteria were applied, the search results yielded 33 articles. These studies were subjected to a thematic analysis as described by Braun and Clarke (2006). This entailed (1) multiple readings by the three authors; (2) identifying patterns across studies by coding and charting specific features; (3) examining disclosure definitions used, sample characteristics, and measures utilized; and (4) major findings were extrapolated. Reading of the articles was initially conducted by the authors to identify general trends in a first level of analyses and then subsequently to identify themes through a deeper second-level analyses. A table of studies was generated and was continuously revised as the selection of studies was refined (see Table 1). ## Key Findings First-level analysis of the studies identified key study characteristics. Trends emerged around definitions of CSA disclosure, study designs, and sampling issues. First, in regard to definitions, the term “telling” is most frequently used in place of the term disclosure. In the absence of standardized questionnaires or disclosure instruments, telling emerges as a practical term more readily understood by study participants. Several EFTA00088890 Table 1. Ch d Sexua Abuse (CSA) D scosure Stud es: 2000–2016.
StudyPurposeDes gnSamp eFind ngsSummary
Gauge er and Co n-Vezra(2016)To exp ore dsc course processes for me m vctms of CSAPhenomenon og ca methodus og used to ternew ma CSA survors. The Long Interw Method(LIM) guided data co act on and ana yes.17 med maged n age from 18 to the aa age. Purpos vamp ng strategy was usedThe major of the men n the study on edt and ud, should to dcn the aa bnt, w negt we stereotypes counter to ther de dyed dsc courses. Negt we stereotypes counter to deyed dsc courses so at csc uae w th the aa of our forms w such tha y ad vator to dsc uae w co act on c 262 EFTA00088891 Table 1. (contnued)
StudyPurposeDesgnSampteFnd tgsSummary
M.E.vaney and Cu hane (2013)To ness gave the feast b by t of ugh d assessments of informa CSA d scour. To assess if these reports proves substantive data on dscoursF report on dren seen for assessment n a ch d sexua abuse untainted ha dren's hospita were rev ewedand 17 years o d, Majority w of White, unducted, a most ha dren oyded before the rrest concern for the rrestthe time during the offence, or f the vct m resisted 263 EFTA00088892 Table 1. (cont nued)
StudyPurposeDesgnSamp eFindingsSummary
Easton (2013)Study purpose was to describe me a CSA d scourse processes us tig a fe spans approach ness ng d disen to oem w to oem ps between d scourse artr butes and men's hea thCross-sect ons survey d g en g E g e part c parts were screened and comped oem and intermnetised survey dur ing 2010. Measures used: Genera Hea th D stress Sca e and Genera Assessment of Ind v Need. Quest one re ated to CSA scourse and supra were ncudPurpos ve samp e of 487 ve m from three nat anions organ az ons devoted to rg awareness of CSA range of 19-84 years. Mean age for onset of CSA was 10.3 yearsO der age and be ng abused by a fam y member be ne ng abused to de yns n d disure. Most pants who do d someone par 264 EFTA00088893 Table 1. (cont nued)
StudyPurposeDesgnSampieFind ntsSummary
Hunter(2011)A m of th study was to devep a fu er understand ng of CSA d sc osuresdata, sexua v ctm zat on, genera, and menta heath. Sexua Assus t Modu e v ctm zat on Ques tion mae was usedcommunity and counse ng serv osnot to burden them. Ear er d sc osures were reated to extrifam CSA, rng e occurrence CSA, age of ct m at abuse onset, and parents who were in vrg together. Hgher w f of reported g t and shame were reated to deyed d sc osures. The m n hbh s tamp are made more reable. re b effd cutsresearch and beers more exam nat on
Schaffer, Leventha, and Asnes(2011)This study a need to (1) add d rect nquy about the process of ch d's CSA d sc osure; (2) determine me ch dren w d scuss process to be able to be factors that ch dren fty that ch dmen te about or caused them to be CSA d sc osureNarrat ve iqnry methods og. Face-to-face in-depth conducted w th part of enw were inspected w th part of enw were inspected w th part of enw Rossetta, and f孝er Rossetta's (2004) method.Purpos ve samp ng was empoyed. Samp e consSED of 25-70 years; 13 women pants with men's pants when worn. Pants were further exposed usng A mg Agg's (2004) framework ver fying bora nd rect attempts to verb and purposeful d sc osure as categor e. Themat aana ys supported that CSA d sc osure should d be concep tual and vewed a comp ex anneDeayed d sc osure was common in th m a t ve samp e. Most part c pants d not make a sect v d sc osure unt ad showd These find ng support Agg's (2004) was used but did not lift the importance of fe stage. Modern but suff c tent sze for a qua tat quny. We-desgred study to det yd anayays for find ngs
This study a need to (1) add d rect nquy about the process of ch d's CSA d sc osure; (2) determine me ch dren w d scuss process to be able to be factors that ch dren fty that ch dmen te about or caused them to be CSA d sc osureStudy sought to out f process ssure of d sc osure cou b context n of enw the context n of enw part n of enw Forsena. Forsena were asked to report question about "te ng" no ex st ng forensic n of enw protoco nterested to the ch dren reasons for te ng ve, exstracted, transcer bed, and ana yed ung grounded theory of anayays19) nerves of CSA v ctm msaged = 18 over a 1-year per d were used for the study. lic us on ur tor n made ch dren who needed CSA knowledge for referrs, reasons for te, and those who spoke fsh. Part c pants were ch dren who were in nervous state for te ng ve, exstracted, transcer bed, and ana yed ung grounded theory of anayaysReasons for the ch dren dent fed for te ng were cased as a result of three domains: (1) the c d was a result of a stm mu (e.g., the ch d had grimware); (2) d sc osure faxed out by nfuses (e.g., the ch d was quested); and (3) the ch d was due to the abuse was not nused). The hurt ars to d sc Osure dent fed ffe not i groups: (1) threats made by the perpetrator (e.g., the ch d was to she or he wife) (2) fears get n troubled if she or he d) (3) ask of the opportunity to d sc Osure present), (4) ask of understanding (e.g., the ch d fd to recogize az abwe belav or as unaccepted), and (5) re at onsph w the perpetrator (e.g., the ch d thought the perpetrator was a friend)An novowae study to try assess form invest gt ve interw can f艺 tate d coourse of an女 data were based on an女 yas produced deta d frnd ng support other study find ng on CSA d sc osure
(continued) 265 EFTA00088894 Table 1. (cont nued)
StudyPurposeSamp eFind ngsSummary
A agg a (2010)The study aimed to detect factors impeding or promoting CSA d scourse. Overarching research quest on: What nd v.dua, interpersonal, environment, and contextual nuences need to promote CSA d scourse.A qua tat ve pheno meno og ca des gn, LM, was used to track survivors about the d scourse exper ences to prov de retrospective accounts of CSA d scourse and mean ngm rg of the Themat a and ys was done through a soc a eco og ca ens.Purpos ve scmp ng was emp oyped. Snowbaw tmg was so used to track survivors about the d scourse exper ences to prov de retrospective accounts of CSA men and 64% women. Age range of 65-85 w. with an age range of 40 years. After onset was 3 yrs o d.3 mm non-Whte. D verse soc oeconem c backgrounds.Themes tng no four domains:(1) nd v dua and deve opmenta factors, deve opmenta factors as to highest ingression trg tra as to have some bater in trg to te and tnt d ng not be ng be eved;(2) mg tmb bted by fam y character sts such as r gdy fxd gender rms of with domain ngfathers, rms of with domain ngfathers, d ch abuse, d ch abuse, d ch dysfunctiona commun caton, and soc a os at;(3) ne ghborhood and community context, that sck interest from glibor and teacher not purus ng tub ng be eror; and cyu tnb and cyu tnb attudes tred, fee ng unheard as it dc gender a zat on for ms, and it dcura attudes nfucng parent's reac tions. Purposed, d scourse s hler than reported n other studies because of the same attempts to prove d scourse.The study presents a comprehenss to soc a eco og ca anys ts to CSA d scourse high tgt ng the most important factor, 42% had d scused the abuse durig ch dihoo, 26% had not d scosed they had attempted some form of d scourse o n d rct垂 way durig ch dihoo. A retrospect has appealed to coul be affected by reca sses
Fontes and Pummer (2010)This exam nat on of CSA d scourse exp ored the ways cuur affects processes of CSA d scourse and report both the Us internat om a yUs pub shed terature wth n cna data, this art e conducted an ans ys to prov de a cru competent framework for CSA d scourse on ngData cons std of pub shed terature on d scourse and cur that was triangulated wth c c na case matter aCuura and structurc factors affect d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(1) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(2) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(3) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(4) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(5) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(6) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(7) d scourse are dent f tn n-depth data. 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Recommenden made nc堑 data.(120) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(121) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(122) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(123) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(124) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(125) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(126) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(127) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(128) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(129) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(130) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(131) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(132) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(133) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(134) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(135) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(136) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(137) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(138) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(139) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(140) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(141) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(142) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(143) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(144) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(145) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(146) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(147) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(148) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(149) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(150) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(151) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(152) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(153) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(154) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(155) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(156) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(157) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(158) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(159) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(160) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(161) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(162) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(163) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(164) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(165) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(166) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(167) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(168) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(169) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(170) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(171) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(172) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(173) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(174) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(175) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(176) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(177) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(178) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(179) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(180) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(181) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(182) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(183) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(184) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(185) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(186) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(187) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(188) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(189) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(190) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(191) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(192) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(193) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(194) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(195) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(196) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(197) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(198) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(199) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(200) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(201) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(202) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(203) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(204) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(205) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(206) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(207) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(208) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(209) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(210) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(211) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(212) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(213) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(214) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(215) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(216) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(217) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(218) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(219) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(220) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(221) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(222) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(223) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(224) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(225) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(226) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(227) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(228) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(229) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(230) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(231) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(232) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(233) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(234) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(235) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(236) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(237) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(238) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(239) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(240) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(241) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(242) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(243) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(244) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(245) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(246) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(247) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(248) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(249) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(250) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(251) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(252) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(253) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(254) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(255) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(256) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(257) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(258) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(259) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(260) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(261) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(262) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(263) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(264) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(265) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(266) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(267) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(268) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(269) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(270) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(271) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(272) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(273) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(274) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(275) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(276) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(277) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(278) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(279) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(280) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(281) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(282) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(283) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(284) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(285) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(286) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(287) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(288) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.(289) d scourse are dent f tn n-depth data. Recommenden made nc堑 data.( 266 EFTA00088895
Table 1. (cont nued)
StudyPurposeDesgnSampleFindingsSummary
Unger, Tutty, McConne, Barter, and Fa rho m(2009k)This study exp ored abuse of scour strategies w ith a Canda s tame of Ciara youth who part cased n o oense prevent on program ng. One of the goa of the study was to document not pre ous y d fered exper ences of abuse and youth found t d of scour of abuse exper encesProgramming by the Canada an Red Cross (RespectED)A ser es of focus groups and observing of the programs were used on youth to express the r abuse exper ence? (3) What d scour bark er w ith yoa face? (4) What are young people d d person? (5) Who do they te?anonymous y d scosed abuse exper ences.Respondent's age: 13 and under(17%):14-15(37%),16-17(25%),18 and over(7%)unknown(7%)at a about the abuse to prevent nrus vs intervenents by others; see ing hep from peers; seek ng he from pharma; support and support for pps from mandated service providers (6); rest us suggest d scourse at a interact process, with expectant regn gings consequences to d scourse.Patterns of increments y har ng abuse exper ences are shaped by young people's interact on w peers, educators, and caregivers.Above three qeems for d scourse; get caurty d scosedinteract vex modes of d scourse such as those deated by Agg a(2004) and So a er and Ne son-GR(2005). This m sed sample eough牙 who expore enced d scourse and w o ence expore enced w even part cants-not to CSA survors
Unger, Tutty, McConne, Barter, and Fa rho m(2009k)This study exp ored abuse of scour strateges w ith a Canda s tame of Ciara youth who part cased n o oense prevent on program ng. One of the goa of the study was to document not pre ous y d fered exper ences of abuse and youth found t d of scour of abuse exper encesExp ortation gwn w ith nonrepresentew amps. Qua ta vie que tota forms of anonymous abuse.Do part cases of inject emoia, phys a, and sexua abuse.Twenty-seven interview and focus groups were so done to understand com positions and engage youth and program fac tutors on the intercept on fnd signs.A cod ng structure was deveoped for ana ys to synthze ze themes across data sourcesPurposefu samp e of 1,099 eva uat on forms competed for owig Red Cross RespectED on program ng.deveared on programng.De vered between 2000 and 2003.Forms of anonymous abuse.Do part cases of inject emoia, phys a, and sexua abuse.Twenty-seven interview and focus groups were so done to understand compositions and engage youth and program fac tutors on the intercept on fnd signs.A cod ng structure was deveoped for ana ys to synthze ze themes across data sourcesFindings suggest h gnts of hd abuse.wh es than one quarter of 1,099 eva uat on scourse abused on her r dda than on the abuse D scourse patterns vary th boyy.youth aged 14-15,vctms of phys a abuse,and those abused by a famymember on or the po k.One r th of d scourse were drected award.parts each ewd toward t ends.parent, and others.Part cants were most key to d scourse abuse to parent/faculty,y professors,s and the po/eilcuftys,w fewer choos f ends.Innovat ve des gn of th study prov des n gt into young peers e perceptions of d scourse experiences.High eve of gor wh is ensured through use of youth focus groups, interviews, and observatona data.The study resus ts are somewhat m ed th the chkness of the descrip mt of the data can be surveyed.Regina dled up,some of the study s broad and approach s creaveto
(continued) 267 EFTA00088896
StudyPurposeDes gnSamp eFnd tgsSummary
Prebe and Sved n(2008)The study aimed to investigate dScourse rates and dScourse patterns and examine performance of sex education on a sample of mae and fema e mpe excerits with se f-reported experences of sex abusePart c pants competed 65 men quest omna re that ncured questions about background, context, contact or parenting abuse (noncontact, contact or parenting abuse), dScourse of CSA own sexua exp at beetu and experences with pornography and sexuation exp at tion. The question re ncused 6 male nced tion from CSU-890 and 9 of 25 tions from the Parenta Bond Instrument. The data for grs and boys were analyzed separatelyThe samp e cons sted of 4,339 high school students n Sweden (2,324 grs and 10,105 boys) The age of the part c pants included 18,15 years. This study was conducted with a subsample of 1,962 part c pants who reported dScourse questionsThe samp e cons sted of 4,339 high school students n Sweden (2,324 grs and 10,105 boys) The age of the part c pants included 18,15 years. This study was conducted with a subsample of 1,962 part c pants who reported dScourse questionsThis study high gthed from sex abuse s age y dden from adult profiles a y from system abuse s eve not reported by peers vd we consequences of owing dScourse to our sex abuse
Sorso, K=Keat ng, and Grossman(2008)Study focused on dScourse tha enges for mae survors of three sues:(1) ToMa e survors of CSA were interviewed about the ture of dScourse exerces. Ama y c techques ncuedThe samp e cons sted of 16 ma survors of chdood sexua abuse: 1 Caucasan: 2 AIrcan Amer: 1Barrers of dScourse were found to operant in three interrelated domains: (1) persona (e.g.,ack of cognit awareness, intent naive dance). emotion, intent naive舞, shamed)Since the vast majority of men the samp e not dcused n chdood they may have been probed posed to deny firing barrers of dScourse were found to operant in three interrelated domains: (1) persona (e.g.,ack of cognit awareness, intent naive舞, shamed)
268 EFTA00088897 Table 1. (contnued)
StudyPurposeDes gnSampleFind ngsSummary
Hershkowitz, Lannes, and Lamb (2007)whom and what contexts have they d sc oed these exer ence? (2) What do they have to say about the r d sc oure exer ence? and (3) What do perceptions of pos t and regnt ve aspects of the r d sc oure, nc rd ng nt venes and barr enz?grounded theory method of ana ys for cod ting and deve opment of concepta c cysted mar ee. Part c y pletes comp eted two n- deviated ntew evs, ast tg between 2 and 3 hr each tak ng p ace approx maze y a week apartPuerto Rican can, i part Natv v Amer can, i part African Cuban; age range of 24-41 years; n dent fed threes via heterosexia, .5 as homosexual, .2 as bsexualre at ons (e.g., fears about neggt repercussions, so at on); and (3) soc ocu turn (e.g., ask of acceptance for men to exper ence or acknowl edge v cr t z at on). Only if the 16 men th s sample e soc cu turn the flu extent of the x sexual be ch. The other men reported that they had not d coed, a though not reported attempts to te that were nd rect or ncomp ete. Severen other men d coed certa x sexual ences or elements of the r abuse, but conca ce of ones by them (the study summary of those men had d coed the great exp er ences n a varity of w a mth px, nc uid those with fum y members, partners, therapists, and infrequent friends. Seva had only m ted d cousins of the r sexua abuseread, Retrospect ve accounts are subject to rea; sues. Investators gather a g风 cant e. H gh ew of ror was executed in the dependab y of the data and their process of the inpreprents of find ngs was conducted
Hershkowitz, Lannes, and Lamb (2007)The goa of the present health care for the how d r v er m of extratism a sexua abuse d coed the abuse exper enceAged vcrts of sexua and nr parents even. Ch dren were ntered ung the NICNED Instrget get we interew lnvesto by expert erfect youth nurses informam on d scoure processes was oben ned n the first forma nterew, before any poe nvest gon or ch d we are intervenent onThey a aged vcrts of sexua and 12 crs. B boy and 12 crs. Ch dren were d seven to an average age of 22 years. Twenty mothers and 10 father evened a so ryua (continued) 269 EFTA00088898
StudyPurposeDesgnSampleFind rgsSummary
A agg a and K rhenbaum (2005)The object ves of the object study were to dentfy a broad range of factors, ncud ng fam y dynas on t conurce at ar ds s ab ty to ncud one CSA.A qua tat ve pheno meno og ca dnm—LIM—was used to ect dsc exper ences, factors and barr on event curtances. Interv ences transfer bed verbat m. L-ne-by, ne open cod ng was conducted to capture fam y e-ve factors. Awr and ing fuc tied dent cat on of themesPurpos vamp ng was empioyed to recu 20 adult survurs between the ages of 18 and 65 who were sexa a abused by a fam member. Avance ng part cants was 40.1 years; 60% of part cants were fema a and 40% me. Avance ng age of abuse was 7.7 years. A major or had recved treatment for CSA at some point n. the rusFour major themes emerged suggesting that major dsc can be grit t安 y cant y compred when certain n fam y cond ex es t: 1 rd g f妥, gender based on patr arm-based fam y structure. (2) presence of parity关系 on the form of the fam y as who o s at on the form of the fam y as who o s vct c members, paved by a fam y ms fee ng they had no one safe to f. fam y systems format on through a fam y ms ens important underng r考 then enfs at rs k of dsc course burnsOver h if the part cants had not oced dsc the abuse during dng ch disph. Of the nord dsc os ng part cants x s x d of sc ose because they had repressed or forgotten the memory. A most onward day of dscuncture. Most onward day of dsc courses needed on ear y dsc courses to garner more information on foc tars of dscourse. Retrocapture approach, mp es reissue. Hugh e high trustworthiness of the data and interpersonal ons were ae wch evended through bred t y, dependabl t y, and confrab t y through d rect quotes
A agg a (2005)The study purpose was to quata tave y sus dynami cs that, mpede or promote dynamic by ncud ng factors, ncud ng gender as a dynamic from dscouses of forma es and mares are sm ar and dfferent, and what ways gender affects CSA dscourseSurvives vamp ng about the r dscourse on dynamic ng LIM. Ava r of 30 part cant wavs was used for thematic development regarding impact of gender on dscourse. Interv enws were transfed verbat m for open, active, and subcategory es were coap and refng nto theme areasPurposes vamp ng of women and男 m whoso thou those ng the form of the family who did not 19 fema s (mean 18 ms i es 18-65 (mean 18 years) who were by a fema s abused by a fema s member a trusted l. A average of absence was 36%. No nonwhita, and 58% had not dscosed during ch disphThree themes emerged for men nh b ther or prp e pated dscourse for reasons re stated to gender. (1) fear of being an abuse person for reasons re stated on or so on because of the fear of boys are rare y vct z nad, and (3) fear of becoming an abuser, with sch acted as a prp e tant for dscourse. Two premodan themes with fema s 270 EFTA00088899
Table I. (contnued)
StudyPurposeDes goSimp goFind goSummary
When CKA vct ms d defense and (2) identify factors associated with different patterns of d scourepo er rg area were referenced for the percent od of June 2001 to December 2003123 boys, average age of 9 years and was 9.9 yearsd scoure (1) perpendicular to d scoure (2) diagonal to d scoure (3) overcrossed to d scoure (4) at right angles to d scourewith the percentage of interater age 89%, General zab t y of this study m ted to ch t ence rce vig a rs assessment referred through a po ce report
Hershkow tz. Hooruz tz. and Lamb (2005)The study aimed to dentify character stcs of suspected ch d abuse vct ms that are associated with d scoure and need to undergo forma. invest gonsLarge database of suspected cases of suspected ch d abuse and sexua abuse nvestged n line between 1998 and 2002 was ana-zed later conducted using standardized NICHRT invest gons NICHRT Protoco arva data were anyzedThe sample e was comprised of 2646 of 3 to 14-year-old e.g. sexua and physua abuse nvestged n line between 1998 and 2002 was ana-zed later conducted using standardized NICHRT invest gons NICHRT Protoco arva data were anyzedOvers a 655% of the 2646 ch d made an onset when愈蛾. Rates of d scoure were greater for sexua abuse (71%) overphyxa abuse (61%). Overs a age were less ky to d scoure because abuse nvestged n line between 1998 and 2002 was ana-zed later conducted using standardized NICHRT invest gons NICHRT Protoco arva data were anyzedOvers f ndrs and cated that rates of d scoure var systemat ca y depending on the nature of the aton p between a aged vct ms and insulated perpetrator. Doses increased as ch d grew ower 50% th to 7-9 years, 67% of the 7-10 year, and 7% of the 11-14 year. Dscoure ds oused abuse when quened
Jensen, Gu bronden, Mga ge, tch. t and Tiers and (2005)The study nested the context t h ch ch were abe b to report the ch d sexua abuse experiences; the r vect ms d to be abe b abuse what he fed them the d d scoure process; and the r parent's perceptions of the d scoure processesQa ta approach to data co ct and ansys was used. Therapeutic nvews o the ch chren mothers y were ysed through a CSA Ch ch chren. Fow ovie nvews were he d 1 year after20 fem es wi th tota of 22 ch chren part cased. A ch chren had o d about experices concerns for caregivers with CACh ch chren. For ovie nvews were he d 1 year afterNone of the ch chren did o abuse maze after o cured. Ch chren exposed to repet ve weeks th as a secret for up to seven years. 17 th o the rmother's first t fro d i畏 t the father, and t the uncle. To the use of CACh ch chren, some someone engaged the ch d n a d aogue about what was bothered him, resu ing n a referral. The ch chren fe t w was difft to tnd t must contain n g through prvy and prompt you to the eye ences. When the ch chren dd scoure a fundamenta y d og a process that becomes ess that s an opportunity t f ch chren peve t he s an opportunity t f ch chren peve t t (continued) 271 EFTA00088900
StudyPurposeDes gnSump eFul tagsSummary
Sa er and Ne son-Garde (2005)The purpose of this study was to understand the fu process of CSA d scour and how the predeceased and ado extent g r s. Examined what fac, tated and hindered d scour and subsequent consequencesSecondary anaysis of qua ta ve focus group data. Or g ns project consist of four focus groups with the context of ongoing therapy for g r s who had experienced CSA Secondary anaysis consist of war ten minutes of each session on group these concepita y, these concepita y, the nterconnectednessSump e consisted of 34 part-parts from four groups: Ses ons ana zed were consist of 689 or 90 min ong and capped and after tracer bed for content anaysisFul tags are reported in three major domains: (1) sephase: where chren come to understand vct maze on interna y (2) containt seectonics at time, pace and person to to, and whether that person's react on was support or host or host and cured (3) consequences phase: good and bad that contuded to oreg strategies of de g. The act one and reactive ones informed the g r s of de g. The consequences phase was further subv aled no four aspects: (1) gross p ng and news networks, (2) chng p ng on onchps, (3) nuttone responses and the after f de g, and (4) Ug purpose empoyed LM—a phenoemo og ma des ntenvs ve intens ve hr on average gege themat a ans ys. The nervew gu de wasThis study proved a contextual examation of the entire point n t nine when the abuse and dscours occurred and added agents who had survived wed suces abuse as consultants and were encouraged to share the k knowledge for the benefit of profins on practices
A aga (2004)The study sought to examine nf nuences that nh b t d scour promote ch dren's d scour of CSA to address gaps n knowledge about how, when and c circumstances ct ms of CSA d scourThe study empoyed LM—a phenoemo og ma des ntenvs ve hr on average gege themat a ans ys. The nervew gu de wasUg purpose empoyed 24 adultsurvives of ntram a abuse between ages of 18 and 65 (average age 1.2), were recurred from wes ys. 57% ma e and 43% fema eThrough an analysis of the nervew new categories of d scour were not f ed to add to ex tr types. Three previous ys didnt require m n these d scour, purposed, and prompted a c accounted for 24% of recall events that occurred in memory ys. ure when memoress were forgotten.This study expanded types of CSA d courses to move fu y understand chren d chren and ads t d csoe. And under what c currencies. Ask pgoe to en记 recurrent events that occurred in memory ys. ure when memoress were forgotten.
272 EFTA00088901
StudyPurposeDes gnSamp eaverage age at schoolFndingsSummary
Cr, sma, Basce · Pac, and Rom to (2004)The ma n goa of th’s study were to understand impaired what proves ado excerbs from dsc osc hp from the rsc a network and/or the servicesIn-depth te phone (anonymous) nterv wws were excerbs informed consent was exp a ned and obta ned. Three gators exper enced n course ng CSA course ng conducted there were recorded with perm ss on. Three researchers independent the nterv wws accorded to dsc osc hp reportThe sampe w was at school for 65 years; 42% of the part c pants had been used the abdion; 58% ch odocd.; 58% ch scod at adultsThe sampe w was at school for 65 years; 42% of the part c pants had been used the abdion; 58% ch odocd.; 58% ch scod at adultsprev ous estate shed categor es. Three add tona d scourse categories emerged beha ora and rect. weba enlarged them. We ment ona y white and dark scourses trigerged by recovered internesde ayed, or rested on and recovered, or stored on and res on events are a so potent of events are a so high degree of transformations in the data was achived and quotes provided supported the research
Jonathan and Lutb ad (2004)Study purpose was to oo tra ts, openness, rest ons to CSA d sccourse, and a support were reated. Differences based on severity of abuse. The majority of dsc course, soc a support, and pred ctng factors of post vte and negat react ons were probedAnonymous nterv wws were excerbs informed consent was exp a ned and obta ned. Three gators exper enced n course ng CSA course ng conducted there were recorded with perm ss on. Three researchers independent the nterv wws accorded to dsc osc hp reportThe sampe w was at school for 65 years; 42% of the part c pants had been used the abdion; 58% ch odocd.; 58% ch scod at adultsThe sampe w was at school for 65 years; 42% of the part c pants had been used the abdion; 58% ch odocd.; 58% ch scod at adultsThe ma n impedes to dsc ose to a girl m member means to dsc ose to a girl m member means to fear of not be ng beav, shame, and 273 EFTA00088902
StudyPurposeDes gnSamp eFindingsSummary
Kogan(2004)The purpose of the study was to test factors that influence the duration of fema survies of USE n ch dhood and ado existence.The pred cors of both the tm ng of scuress and the rec pent of the scuress were never gainedData were gathered from a subsample of fema ado exceptions that parted out of the NSA, whch conts used of structured phone nterv uses.USE reported the NSA were assessed uss on the life time of the interv.They were then asked about each epode of unwanted contact nc tgng event characteristic and periphery character stcsA subsample of 263 ado existence data between 1 and 17 years of age of 15.2 years of age were reported at east one expert experience of unwanted sexual contact nc tgng event characteristic USE character stcs and fun contextual attr contexus were exporedCh dhood under the age of 7 were at a higher rk for deyed wts at our site.Part pants whose USE occurred key to be deyed ado exceptions (4-7) were more key to be on pants than dh aged 10-19 years. Ch dhood under experients may be bred due to underreporting.Measured by report of a discus in the study may have been used to note the system of system to be used make the result genera able on y to ado exceptions who are w ng to dscus use a survey.Reach data may be retrospective, reca baisly have been used to note the system of system to be used make the result genera able on y to ado exceptions who are w ng to dscus use a survey.Reach data may be retrospective, reca baisi 274 EFTA00088903 Table 1. (contnued)
StudyPurposeDes gnSamp eF nd ngsSummary
questonna for ch d character stc, the abuse and the r d csoure. Ch d'renn percept on b y and fear of negutive consequences were reported.n t a po ce report: 7% fema an, 70% Cuscan an, 17% Husp c and 11% Afr can Amer can. Predonnt妈 m dd to ow SES. Approximate 47% nismaf a abusenegutive consequences of d csoure took on d csouse, ch d who brig harm to others took on d csouse, fear of negutive consequences on b se for the perpetrator was unrated to time of t he d csouse, and g r s more than boys feared negutive consequences by ch d ch d when g r s feared responbts b y for the abuse cook, on d csouse and d ch d ch d when g r s feared responbts b y for the abuse cook, and (5) gender was not to g f tany corne sed w t he t to d csousenegutive consequences to d csoung took on t he d csouse. We -des gned study w h gh eve - des gned study w h gh eve mode of d csouce for further invest gat ones. However, researchers were not ab to interw ch dren d recty
Sm th. Leourmeau, Saunier, pait ck, Renck ck, and Best (2000)The study focus was to gather data from aarge sample of women about the age of t m woman who were raped before age 18 deeds before age 18 who they dsced to, and var ab es that predced d csouce with n l monthStructured tephone intervew that asted approve my 35 m t each question was asked to a computer screen. The survey consisted of seven measures designed for ct demograph inform on, psych ar c symptoms, substance use, and vct m zat on h story. The present study reports on data from the demograph c and ch d vct m zat on quest oneTwo probabt ty sampes. Wave 1 was a random sample of 2009 sampes selected from strata d samp es of def ned jur std cns. Random d tga d ng was used to s ted houselho for each question on a computer screen. The survey consisted of seven measures designed for ct demograph inform on, psych ar c symptoms, substance use, and vct m zat on h story. The present study reports on data from the demograph c and ch d vct m zat on quest one288 (9%) reported exper encing at east n(one) event that met the study's delt n on ch of chroid rape. The average age of the time of t he chroid woman who worked a ch d 28% stated that she never had t any anyone that she suxx ass umt speca f y daing so her interwer for t study, 58% d not s for over 1 year and up to 9 years post-rape. 25% d soeded w t h a m post-ang women who did so pror to the NWS 275 EFTA00088904 276 TRAUMA, VIOLENCE, & ABUSE 20(2) examples of this usage were found in the research questions, interview guides, and surveys examined: “How and when do people decide to tell others about their early sexual experiences with adults?” (Hunter, 2011, p. 161); “Some men take many years to tell someone that they were sexually abused. Please describe why it may be difficult for men to tell about/discuss the sexual abuse” (Easton, Saltzman, & Willis, 2014, p. 462). “Participants were asked a series of open-ended questions to elicit a narrative regarding their experiences of telling . . .” (McElvaney, Greene, & Hogan, 2012, p. 1160). “Who was the first person you told?” (Schaeffer, Leventhal, & Anes, 2011, p. 346). There was sound consistency between studies, defining disclosure in multifaceted ways with uniform use of categories of prompted, purposeful, withheld, accidental, direct, and indirect. However, defining the period of time that would delineate a disclosure as delayed varied widely across studies, wherein some studies viewed 1 week or 1 month as a delayed disclosure (i.e., Hershkowitz et al., 2007; Kogan, 2004; Schönbucher, Maier, Moher-Kuo, Schnyder, & Lamdolt, 2012). Other studies simply reported average years of delay sometimes as long as from 20 to 46 years (Easton, 2013; Jonzon & Linblad, 2004; Smith et al., 2000). Second, the number of qualitative studies has increased significantly over the last 15 years. This rise is in response to a previous dearth of qualitative studies. Based on Jones’s (2000) observation that disclosure factors and outcomes had been well documented through quantitative methods; in a widely read editorial, he recommended “Qualitative studies which are able to track the individual experiences of children and their perception of the influences upon them which led to their disclosure of information are needed to complement . . .” (p. 270). Third, although a few studies strived to obtain representative samples in quantitative investigations (Hershkowitz, Horowitz, & Lamb, 2005; Kogan, 2004; Smith et al., 2000), sampling was for the most part convenience based, relying on voluntary participation in surveys and consent-based participation in file reviews (Collings, Griffiths, & Kumalo, 2005; Priebe & Svedin, 2008; Schönbucher et al., 2012; Ungar, Barter, McConnell, Tutty, & Fairholm, 2009a). Therefore, generalizability of findings is understandably limited. The qualitative studies used purposive sampling as is deemed appropriate for transferability of findings to similar populations. Some of those samples contained unique characteristics, since they were sought through counseling centers or sexual advocacy groups. These would be considered clinical samples producing results based on disclosures that may have been delayed or problematic. This might presumably produce data skewed toward barriers and bring forward less information on disclosure facilitators. Through an in-depth, second-level analysis, this review identified five distinct themes and subthemes beyond the general trends as noted earlier. **Theme 1:** Disclosure is viewed as an ongoing process as opposed to a discrete event—iterative and interactive in nature. A subtheme was identified regarding disclosure as being facilitated within a dialogical and relational context is being more clearly delineated. **Theme 2:** Contemporary disclosure models reflect a social–ecological, person-in-environment perspective to understand the complex interplay of individual, familial, contextual, and cultural factors involved in CSA disclosure. Subthemes include new categories of disclosure and a growing focus on previously missing cultural and contextual factors. **Theme 3:** Age and gender are strong predictors for delaying disclosure or withholding disclosure with trends showing fewer disclosures by younger children and boys. One subtheme emerged that intrafamilial abuse/family-like relationship of perpetrator has a bearing on disclosure delays or withholding. **Theme 4:** There is a lack of a cohesive life-course perspective. One subtheme includes the lack of data within the 18-to 24-year-old emerging adult population. **Theme 5:** Significantly more information is available on barriers than on facilitators of CSA disclosure. Subthemes of shame, self-blame, and fear are uniformly identified as disclosure deterrents. Disclosure as an ongoing process: Iterative and interactive in nature. Disclosure is now generally accepted as a complex and lifelong process, with current trends showing that CSA disclosures are too often delayed until adulthood (Collin-Vézina et al., 2015; Easton, 2013; Hunter, 2011). Knowledge building about CSA disclosure has moved in the direction of understanding this as an iterative and interactive process rather than a discrete, one-time event. Since the new millennium, disclosure is being viewed as a dynamic, rather than static, process and described “not as a single event but rather a carefully measured process” (Alaggia, 2005, p. 455). The catalyst for this view originates from Summit (1983) who initially conceptualized CSA disclosures as process based, although this notion was not fully explored until several years later. Examinations of Summit’s (1983) groundbreaking proposition of the CSA accommodation (CSAA) model produced varying results as to whether his five stages of secrecy, helplessness, entrapment and accommodation, delayed, conflicted, and unconvincing disclosures, and retraction or recantation, hold validity (for a review, see London, Bruck, Ceci, & Shuman, 2005). However, the idea of disclosure as a process has been carried over into contemporary thinking. Recently, McElvaney, Greene, and Hogan (2012) detailed a process model of disclosure wherein they describe an interaction of internal factors with external motivators which they liken to a “pressure cooker” effect, preceded by a period of containment of the secret. Moreover, this and other studies strongly suggest disclosures are more likely to occur within a dialogical context—activated by discussions of abuse or prevention forums providing information about sexual abuse (Hershkowitz et al., 2005; Jensen, Gulbrandsen, Mossige, Reichelt, & Tjersland, 2005; Ungar et al., 2009a). The term EFTA00088905 Alaggia et al. 277 dialogical simply means to participate in dialogue. Key dialogical vehicles identified in these studies were providing sexual abuse information through prevention programs, being asked about sexual abuse, and being prompted to tell (McElvaney et al., 2012; Ungar et al., 2009a). Contemporary models of CSA disclosure reflect a social-ecological perspective. Knowledge on CSA disclosure has been steadily advancing toward a holistic understanding of the complex interplay of individual, familial, contextual, and cultural factors (Alaggia & Kirshenbaum, 2005; Brazelton, 2015; Fontes & Plummer, 2010). Where at one time factors examined and identified were predominantly of intrapersonal factors of child victims, knowledge construction has shifted to fuller social–ecological, person-in-environment explanations (Alaggia, 2010; Collin-Vézina et al., 2015; Easton et al., 2014; Hunter, 2011; Ungar, Tutty, McConnell, Barter, & Fairholm, 2009b). Social–ecological explanations open up more opportunities to intervene in facilitating earlier disclosures. Alaggia (2010) proposes an ecological mapping of what individual, interpersonal, environmental, and contextual influences impede or promote CSA disclosures based on analysis of in-depth interview data of 40 adult survivors. Subsequently, based on a sample of 67 adult survivors, Collin-Vézina, Sablonni, Palmer, and Milne (2015) identified three broad categories, closely aligned with an ecological framework that impede CSA disclosure: (1) barriers from within, (2) barriers in relation to others, and (3) barriers in relation to the social world which can be aligned to intrapersonal, interpersonal, and contextual factors. A summary of knowledge building using a social–ecological framework follows. Knowledge gained in the intrapersonal domain includes expanded conceptualization of disclosure by building on previous categories of accidental, purposeful, and prompted disclosure to also include behavioral and indirect attempts to tell, intentionally withheld disclosure, and triggered and recovered memories (Alaggia, 2004). Categories of indirect behavioral disclosure patterns have been further verified in follow-up research by Hunter (2011), and through an extensive file review that used Alaggia’s (2004) disclosure framework to analyze their data (Collings et al., 2005) for verification. Interpersonal factors have also emerged in regard to certain family characteristics as disclosure barriers. Families with rigidly fixed gender roles, patriarchal attitudes, power imbalances, other forms of child abuse and domestic violence, chaotic family structure, dysfunctional communication, and social isolation have been found to suppress disclosure (Alaggia & Kirshenbaum, 2005; Collin-Vézina et al., 2015; Fontes & Plummer, 2010). In addition, relationship with perpetrator is a factor whereby research indicates that disclosure is made more difficult when the perpetrator is a family member or close to the family (Dumont, Messerschmitt, Vila, Bohu, & Rey-Salmon, 2014; Easton, 2013; Goodman-Brown et al., 2003; Hershkowitz et al., 2005; Priebe & Svedin, 2008; Schönbucher et al., 2012). This is especially a barrier when the perpetrator lives with the victim (LeClerc & Wortley, 2015). In terms of environmental factors, one study revealed that neighborhood/community conditions can hinder disclosure when there is lack of school involvement in providing a supportive environment, such as in following up on troubling student behavior (Alaggia, 2010). Additionally, a child victim’s anticipation of a negative response to disclosure, especially that they may not be believed by others outside their family such as neighbors or other community members, has shown to deter disclosure (Collin-Vézina et al., 2015). Cultural factors influencing CSA disclosure have been studied to a much lesser degree. Despite this, a few important studies examining critical sociocultural factors now exist for better understanding CSA disclosure within a cultural context (Brazelton, 2015; Fontes & Plummer, 2010). Among these important contributions, Brazelton’s (2015) research has delineated CSA disclosure processes as “shaped by relational, racial, socio-cultural, historical, and developmental factors” (p. 182). In a unique study using culturally focused research literature as data triangulated with clinical case material, culturally based belief systems in many cultures have been found to foster family climates that can silence children from disclosing abuse (Fontes & Plummer, 2010). Taboos about sexuality, patriarchal attitudes, and devaluation of women are among some of the cultural barriers that inhibit disclosure (Fontes & Plummer, 2010). Clearly, disclosure conceptualizations are being integrated into a social–ecological model of individual and developmental factors, family dynamics, neighborhood, and community context as well as cultural and societal attitudes toward better understanding disclosure barriers and facilitators (Alaggia, 2010), although more data are needed on cultural and contextual factors. ## Age and gender as predictors of disclosure Age. Age is consistently found to be an influential factor in CSA disclosure, making the life stage of the victim/survivor a critical consideration. Studies draw distinctions in age-groups falling into either under or over 18 years of age. Eighteen years of age was the common age cutoff point that investigators chose in order to distinguish child/youth populations from adult samples. Sixteen of the studies drew on samples of children and youth, while the other 15 studies sampled adults over the age of 18, and a further two studies used mixed age-groups (refer to Table 1). Among the child and youth samples, the age ranges spanned from preschool to late adolescence (3–17 years of age), with varying methodological approaches implemented across age cohorts. For younger cohorts, file reviews and secondary data analyses of CSA reports were typically undertaken. Adolescents were most often given surveys. Sometimes children and youth were interviewed as part of administering a survey or as a follow-up (Crisma et al., 2004; Hershkowitz et al., 2005; Ungar et al., 2009b). In the majority of child and adolescent samples, sexual abuse concerns were already flagged to investigative authorities. However, the work of Ungar, Barter, McConnell, Tutty, and Fairholm (2009a, 2009b) is one exception, whereby their survey elicited new disclosures. EFTA00088906 278 TRAUMA, VIOLENCE, & ABUSE 20(2) Adult studies typically had a mean age between 40 and 50 years. Interviews were the main data collection method with a few exceptions using survey designs (i.e., Easton, 2013; Kogan, 2004; Smith et al., 2000) and case file reviews (i.e., Collings et al., 2005; Goodman-Brown et al., 2003). Results show a clear trend toward increased likelihood of disclosure in older youth, and findings from adult samples showing a preponderance of disclosures in adulthood, with the large majority of participants of adults reporting never having had a sexual abuse complaint filed with investigative authorities as a child or an adolescent (i.e., Hunter, 2011; Gagnier & Collin-Vézina, 2016; Sorsoli, Kia-Keating, & Grossman, 2008; Ungar et al., 2009b). With children and youth under the ages of 18 distinct patterns emerged. First, accidental detection, rather than purposeful disclosure, is more likely to occur with younger children. For example, in one large-scale study of over 1,737 file reviews, over half of the CSA-related cases were identified through accidental and eyewitness detection (61%), while less than one third were purposeful disclosures initiated by the child victim (Collings et al., 2005). A second pattern which emerged is that rates of disclosure increase with age, especially into adulthood, which is supported by persistent findings of high rates of delayed disclosure reported later in the life course by adult survivors (Collings et al., 2005; Collin-Vézina et al., 2015; Easton, 2013; Jonzon & Linblad, 2004; Kogan, 2004; Leclerc & Wortley, 2015; Sorsoli et al., 2008). While gender and relationship with the perpetrator are considerable factors in CSA disclosure, age is consistently a stronger predictor of disclosure (or nondisclosure) (Hershkowitz et al., 2005; Leclerc & Wortley, 2015). Third, younger children who disclose are more likely to do so in an interview situation or other environment that provides prompts or questions about sexual abuse (Hershkowitz et al., 2005; McElvaney, Greene, & Hogan, 2014; Schaeffer et al., 2011), but this trend can also be seen in older youth (Ungar et al., 2009a, 2009b). Gender. A number of studies have recently focused on CSA disclosures with male victims, since males have been an understudied population (Alaggia, 2005; Easton, 2013; Easton et al., 2014; Gagnier & Collin-Vézina, 2016). Most investigations that sampled both sexes show females outweighing male participants. Although women are at double the risk of being subjected to CSA, the ratio of women to men in most disclosure studies has not been representative. This finding may be indicative of male victims more likely delaying disclosing their CSA experiences, leaving male disclosure in child and youth samples underrepresented (Hébert, Tourigny, Cyr, McDuff, & Joly, 2009; Ungar et al., 2009b). Easton, Saltzman, and Willis (2014) have been developing gender-specific modeling of disclosure examining male disclosures. Their proposed model groups male disclosures into barrier categories as determined by individual factors, interpersonal issues, and factors that are sociopolitical in nature. These authors suggest that predominant gender norms around masculinity reinforce the tendency for male victims of CSA to blame themselves for the abuse, resulting in no disclosure. Male participants in a subsequent study also relayed that gender norms and stereotypes contributed to them concealing the abuse because they were abused by a woman (Gagnier & Collin-Vézina, 2016). In the one study that compared male and female disclosures, investigator found that men’s fears of being viewed as homosexual; profound feelings of stigmatization or isolation because of the belief that boys are rarely victimized; and fear of becoming an abuser acted as disclosure barriers. Whereas females felt more conflicted about who was responsible for the abuse and more strongly anticipated being blamed and not believed (Alaggia, 2005). Lack of a life-course perspective. Given that the study of CSA disclosure draws on age-groups ranging from samples of very young children to retrospective studies of adult survivors, with significant developmental considerations, this area of study lacks an intentional cohesive life-course perspective. Most data are derived from either cross-sectional or retrospective designs, with few longitudinal studies. There are a series of sound, yet disconnected, studies focusing on specific age-groups of children and adolescents, along with adult retrospective studies. Thus, the available knowledge base does not allow for a cohesive picture of CSA disclosure processes and pathways over the life course to emerge. The life-course perspective has long been recommended as a critical lens for the study of child abuse (Browning & Laumann, 1997; Williams, 2003). For example, a life-course perspective has been utilized to understand the immediate- and long-term effects of CSA on the developing child victim (Browning & Laumann, 1997). Further, a life-course perspective is important in terms of examining age of onset of CSA to explain the differential effects of sexual victimization and developmental impacts in terms of understanding their ability to disclose—effects that need to be understood within a developmental context, especially for designing appropriate interventions for disclosure at critical transitions from early childhood through to adolescence and into adulthood. In addition, important “turning points” in life may facilitate disclosures. For example, entry into adulthood given that delayed disclosure occurs more often in adulthood. Alaggia (2004, 2005) found that being in a committed relationship or the birth of children acted as facilitators for some survivors to disclose, especially to their spouses. These significant life events, as contributing to disclosures, bear further examination. Summary of barriers and facilitators. Research over the past 15 years continues to uncover barriers to CSA disclosure at a higher frequency than that of facilitators. As stated previously, this might be the result of sampling methods whereby participants who volunteer for disclosure research may have had more negative disclosure experiences, especially since many report delays in disclosure. The following section outlines the major trends in both barriers and facilitators (see Table 2). Barriers. Age and gender were found to contribute to barriers as covered in Theme 3. Disclosures generally increase with age EFTA00088907 Alaggia et al. 279 **Table 2. Factors Influencing Child Sexual Abuse Disclosures.**
BarriersFacilitators
Age: The younger the child victim, the less likely they will purposefully disclose.Age: Disclosures increase with age, especially in adulthood.
Gender: Males may be less likely to disclose in childhood/adolescence, fear of being seen as homosexual and as a victim, females experience more self blame and anticipation of being blamed and/or not believedGender: Slight trend toward females who are older(adolescent) to disclose before adulthood
Relationship to perpetrator: If the perpetrator is a family member or in a family like role, disclosure is less likely to happenRelationship to perpetrator: If the perpetrator is not living with the victim, disclosure rates increase
Internal: Shame, self blame, and fear are psychological barriers.In addition, fear of negative consequences on the family and for self safety inhibits disclosureDialogical context: Opportunities to disclose through discussion, therapeutic relationship, information sessions on sexuality,and sexual abuse prevention programs
Family relations: Families with a patriarchal structure, rigidly fixed gender roles,dysfunctional communication,other forms of abuse(i.e., domestic violence),and isolation inhibit disclosureFamily relations: Supportive parent-child relationship.
Environmental and cultural context: Lack of discussion about sexuality;passive acceptance that unwanted sexual experiences are inevitable;not wanting to bring shame to the family by admitting sexual abuse;lack of involvement from neighbors,school personnel;and stigma perpetuated by societal perceptionsEnvironmental and cultural context: Promotion of open discussion of sexuality;community member involvement
as children gain more developmental capacity, understanding of sexual abuse as victimization, and increased independence. Males are somewhat less likely to disclose, but this is often in interaction with other factors in the environment such as societal attitudes that promote hypermasculinity as desirable, attitudes that perpetuate negative views of boys and men who are victims, and homophobic attitudes (Alaggia, 2010; Easton et al., 2014; Gagnier & Collin-Vézina, 2016). Victims of intrafamilial abuse when the offender is a parent, caregiver, significant family member, or someone in a family-like role are less likely to disclose immediately or at all in childhood/adolescence because of obvious power differentials and dependency needs (Collings et al., 2005; Dumont et al., 2014; Hershkowitz et al., 2005; Kogan, 2004; Leclerc & Wortley, 2015; Paine & Hansen, 2002; Schaeffer et al., 2011). Further, the perpetrator residing with their victim(s) increases the likelihood of no disclosure (Leclerc & Wortley, 2015). Internalized victim-blaming, mechanisms to protect oneself (such as minimizing the impact of the abuse), and developmental immaturity at the onset of abuse constituted internal barriers. Further, shame, self-blame, and fear have been identified as significant factors deterring disclosure (Collin-Vézina et al., 2015; Crisma et al., 2004; Goodman-Brown et al., 2003; Hunter, 2011; Kogan, 2004; McElvaney & Culhane, 2015; McElvaney et al., 2014). However, aspects of shame, self-blame and fear, and have not been fully explored in research. Since these are strong predictors of disclosure suppression, they bear further examination in future research to understand more fully how they operate in disclosure processes. In terms of interpersonal and environmental factors, family dynamics can play a part in deterring disclosure. As previously mentioned, families characterized by rigidly defined gender roles, patriarchal attitudes that perpetuate power imbalances between men and women, parents and children, presence of other forms of child abuse and/or domestic violence, chaotic family structure, dysfunctional communication, and social isolation have been found to suppress disclosure (Alaggia & Kirshenbaum, 2005; Collin-Vézina et al., 2015; Fontes & Plummer, 2010). In regard to broader environmental factors, disclosure can be hindered when involved and supportive community members are not available, or not trained in sensitive responses, or when child victims anticipate not being believed by neighbors and other people outside the family (Alaggia, 2010; Collin-Vézina et al., 2015). Further, barriers in relation to the social world were identified as stigmatization, the negative labeling of sexual abuse victims, and taboos surrounding sexuality and talking about sex as driven by cultural norms (Collin-Vézina et al., 2015; Fontes & Plummer, 2010). Identification of cultural barriers is important recent contribution to understanding disclosure processes—and in particular to the obstacles. Findings related to cultural barriers included themes of children’s voices not being heard leading to silencing, the normalization of the sexualization and objectification of girls and women, and the perpetuation of hypermasculinity in men—all acting as barriers in terms of stigma to disclosure (Alaggia, 2005, 2010; Easton et al., 2014). Brazelton (2015) similarly found that lack of discussions about sex, young age at the onset of sexual abuse, therefore not having the language to express what was happening to them, and preserving the family good name by not talking about abuse in the family were also barriers to disclosure. Finally, it may be the case that more barriers continue to be identified over facilitators of CSA disclosure perhaps because of the methods employed in studies—particularly those drawing on adult populations who delayed disclosure. These samples may not be representative of the overall population of CSA victims, since they may have had more negative disclosure EFTA00088908 280 TRAUMA, VIOLENCE, & ABUSE 20(2) experiences, consequently more readily identifying barriers. On the other hand, these findings may speak to the actual imbalance between facilitating factors and barriers for disclosure, the latter carrying more weight in the victims/survivors’ experiences, thus, explaining the high rates of disclosures delayed until adulthood. Facilitators. Although fewer disclosure facilitators are identified in this review, very important facilitators were nonetheless uncovered—ones that should be noted for professionals in this field of practice. Internal factors that facilitate disclosures include symptoms that become unbearable, getting older with increased developmental efficacy, and realizing that an offence was committed (Collin-Vézina et al., 2015; Crisma et al., 2004; Easton, 2013; Hershkowitz et al. 2007; McElavaney, Greene, & Hogan, 2014; Schaeffer et al., 2011). Circumstantial facilitators are those where the child discloses because there has been evidence provided, eye-witnessing has occurred, and a report has been made. Environmental factors include settings that provide opportunities such as counseling, interviews, information sessions and educational forums/workshops, and prevention programs for children and youth to disclose. To elaborate, dialogical contexts about CSA for children and youth can provide opportunities for discussion that may facilitate disclosures (Jensen et al., 2005). The research shows creating open dialogue in relationship contexts, to offset the power and influence of the perpetrator, can facilitate earlier disclosure. Among disclosure facilitators is being asked about abuse and given the opportunity to “tell” (McElavaney et al., 2014); workshops on abuse and sexual abuse, in particular, can facilitate disclosures (Ungar et al., 2009b); and using culturally sensitive probes and questions (Fontes & Plummer, 2010). In Gagnier and Collin-Vézina’s (2016) study, positive disclosure experiences were described by participants as those where they felt that they had been listened to, were safe, were believed, and were not judged by the person they disclosed to. Further, family members and friends (peers) of the child victim can act as key supports to creating an open relational context and fostering positive responses (Jensen et al., 2005; Priebe & Svedin, 2008; Schönbucher et al., 2012; Ungar et al., 2009b). In particular, as children grow older, they are more likely to disclose to a peer, as shown in a number of studies, and this is an important reality for counselors and educators to be aware of (Dumont et al., 2014; Kogan, 2004; Schönbucher et al., 2012; Ungar et al., 2009b). ## Discussion Through examination of 33 studies published since the year 2000, this review identified five distinct themes regarding CSA disclosure: (1) Disclosure is best viewed as an iterative, interactive process rather than a discrete event done within a relational context; (2) contemporary models reflect a social–ecological, person-in-environment framework for understanding the complex interplay of individual, familial, contextual, and cultural factors involved in CSA disclosure; (3) age and gender are significant disclosure factors; (4) there is a lack of a life-course perspective; and (5) barriers to disclosure continue to outweigh facilitators. Based on these themes, a number of conclusions are drawn from this review. First, disclosure as a process is emphasized throughout contemporary research. Advances have been made in understanding these complex processes. However, the disclosure process over time—for example, how the first detection of CSA or attempts to disclose in childhood impact later disclosures—are not well understood. This is the result of the absence of a cohesive life-course perspective in investigations, although age consistently surfaces as significantly influencing CSA disclosure. Using a life-course perspective through the use of longitudinal studies is recommended. The use of varied methodological designs, depending on the developmental stage of the victims/survivors, influences the data generated and subsequent findings. For example, most studies on children and youth are based on file reviews of cases that have been brought to the attention of authorities, or surveys, with only a few studies using interviewing of younger children. Therefore, there is less information available on process issues with children and youth. In contrast, research on adult populations largely favors the use of qualitative interview methods for retrospective inquiry producing important process findings. In addition, investigations have not yet captured the disclosure experiences of adults in the “emerging adult” stage given that adult studies have failed to recognized that the age range of 18–24, which is now considered a developmental phase defined by neurobiological developmental uniqueness. As well, late adulthood has not been given attention as shown by the absence of participants representing this age-group in current research (70+). With a swelling geriatric population in North America, issues of historic CSA can be expected to surface and, with that, new disclosures. This trend is also anticipated due to attitudinal shifts that have presumably occurred over the last two generations about revealing such traumas and changing views about discussing sexual victimization. Interview guides used in a number of studies intentionally probed for facilitators, producing notable findings. For example, one such finding focuses on the importance of creating a contextually supportive environment to promote disclosure across the life course. These include developing therapeutic relational contexts for disclosure by providing information about sexuality, sexual abuse, prevention programming, and by asking directly. Disclosures to professionals are positive outcomes of how therapeutic contexts work; however, for forensic purposes prompting such disclosures would be viewed as problematic in legal settings, seriously compromising testimonies for trial proceedings. This is one example that speaks to the structural barriers victims and survivors run up against time and time again. Facilitators that show evidence to promote disclosure in one domain (therapeutic) are seen to work against CSA survivors in another domain—such as legal settings when perpetrators face prosecution. Defense attorneys will use this as evidence that the disclosure was prompted, and therefore the disclosure is potentially seen as not credible. Broadcasting of EFTA00088909 Alaggia et al. 281 the frequency of acquitted cases or rulings in favor of the perpetrator through media outlets, often sensationalized, become a further compounding barrier. Given the review findings, we conclude that barriers and facilitators to CSA disclosures are nuanced and clearly embedded within intrapersonal, interpersonal, environmental, contextual, and cultural domains—often interlocked in complex ways. ## Limitations Although comprehensive in nature with its life-course coverage, this review may be limited by its qualitative, thematic focus rather than providing an evaluative, quantitative accounting of CSA disclosures. However, because of the recent focus on disclosure processes, the authors chose a suitably compatible approach—qualitative in nature. As well, a traditional checklist approach in rating the studies was not employed for interrater reliability, since two of the authors hold expertise in CSA disclosure research and are well versed with the literature. This expertise, and through closely following a systematic review framework (Kiteley & Stogdon, 2014), assures that a thorough adjudication of the research literature was completed. ## Implications for Research and Practice These review findings have implications that can be useful in guiding future research and practice: - Solid strides are being made in the use of a social—ecological framework to underpin investigations in the CSA disclosure investigations. Research efforts and practice considerations should continue in this vein. Investigating environmental factors and contextual and cultural forces is understudied, necessitating more research in these areas to more fully fill out understanding of CSA disclosure from a social—ecological perspective. - There is good evidence that CSA disclosures are more likely to occur in a dialogical context—formal helping relationships but as well as other relationships such as peers and trusted adults. Providing information and education on topics of sexuality in general, and sexual abuse specifically, can help children and youth to disclose. Raising awareness and prevention programs can promote disclosures of sexual violence committed against children and youth. - Goals of therapeutically supported disclosures (i.e., through therapy) may need to take precedence over forensic approaches, if well-being of child victims and adult survivors is to be made paramount. Legal processes may act to facilitate disclosures but can also act as barriers because of the negative outcomes experienced in the court process. - Practitioners need to keep in mind that the legal system is lagging far behind in knowledge uptake of recent evidence on CSA disclosures so that victims and survivors continue to be systemically and structurally disadvantaged in legal proceedings. - Health-care practitioners (i.e., child abuse pediatricians, family practice doctors, clinical nurse specialists, and public health nurses) should be made aware of the evidence in the CSA disclosure literature to create environments for facilitating therapeutic disclosures. - Given that age is a stable predictor of disclosure of CSA, more studies are needed that make use of a life-course perspective. More longitudinal studies are needed to better identify trends over different life stages. - The emerging young adult as a developmental age group needs specific investigation. Neuroscience research has established that ages 18–24 is a distinct developmental phase. Late adulthood is another life stage that deserves to be researched. - Gender needs to be more fully investigated in relation to impact on disclosure. Awareness that boys and girls have unique challenges and barriers in disclosing CSA should be paramount for practitioners. - Intervention planning should take note that disclosures increase when perpetrators no longer reside with victims, and this finding should be heeded by policy and law makers. - Shame, self-blame, and fear are intrapersonal factors that persistently emerge as barriers to CSA disclosures and warrant more research to understand how to redress these barriers for earlier disclosures. ## Conclusion There are still a substantial number of children and youth who are subjected to sexual abuse, despite preventative efforts. Just as concerning is the fact that many victims continue to suffer in silence as evidenced by the high numbers of delayed disclosure. These hidden cases should not be overlooked, and these victims should not be forgotten. Despite significant progress in bringing the issue of CSA to the forefront, improving facilitation of disclosure and increasing positive influences on disclosure processes are still critical in order to protect current and future generations of children and youth from the grave effects of sexual violence. Further, the focus should not be simply on strengthening and shoring up intrapersonal resources of victims to disclose but rather to change environmental conditions to create a more supportive and safer context for CSA victims and survivors to disclose. ## Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. ## Funding The author(s) received no financial support for the research, author ship, and/or publication of this article. EFTA00088910 282 TRAUMA, VIOLENCE, & ABUSE 20(2) ## References EFTA00088911 Alaggia et al. 283 ## Author Biographies Ramona Alaggia, MSW, PhD, is an associate professor in social work and the Factor Inwentash Chair in Children’s Mental Health at the University of Toronto. Her teaching and research focuses on gender and violence, sexual abuse disclosures, domestic violence exposure, and resilience processes. Delphine Collin-Vézina, PhD, is an associate professor for School of Social Work, McGill University and director for Centre for Research on Children and Families. She holds the Nicolas Steinmetz and Gilles Julien Chair in Social Pediatrics in Community and the Canada Research Chair (Tier II) in Child Welfare. Her work focuses on research and clinical topics related to child maltreatment, child sexual abuse, and trauma. Rusan Lateef, MSW, is a social worker employed in the criminal justice system with adult male offenders in Ontario, Canada. She specializes in the intersection of health and mental health, child sexual abuse disclosures, and she is a researcher on the “Make Resilience Matter” project examining childhood exposure to domestic violence with Dr. Alaggia at the Factor Inwentash Faculty of Social Work, University of Toronto.