Legal Issues in Child Abuse and Neglect Practice

Books

John E.B. Myers

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  • Interpersonal Violence: The Practice Series

    Jon R. Conte, Series Editor

    In this series…

    LEGAL ISSUES IN CHILD ABUSE AND NEGLECT PRACTICE, Second Edition

    by John E. B. Myers

    CHILD ABUSE TRAUMA: Theory and Treatment of the Lasting Effects

    by John N. Briere

    INTERVENTION FOR MEN WHO BATTER: An Ecological Approach

    by Jeffrey L. Edleson and Richard M. Tolman

    COGNITIVE PROCESSING THERAPY FOR RAPE VICTIMS: A Treatment Manual

    by Patricia A. Resick and Monica K. Schnicke

    GROUP TREATMENT OF ADULT INCEST SURVIVORS

    by Mary Ann Donaldson and Susan Cordes-Green

    TEAM INVESTIGATION OF CHILD SEXUAL ABUSE: The Uneasy Alliance

    by Donna Pence and Charles Wilson

    HOW TO INTERVIEW SEXUAL ABUSE VICTIMS: Including the Use of Anatomical Dolls

    by Marcia Morgan, with contributions from Virginia Edwards

    ASSESSING DANGEROUSNESS: Violence by Sexual Offenders, Batterers, and Child Abusers

    Edited by Jacquelyn C. Campbell

    PATTERN CHANGING FOR ABUSED WOMEN: An Educational Program

    by Marilyn Shear Goodman and Beth Creager Fallon

    GROUPWORK WITH CHILDREN OF BATTERED WOMEN: A Practitioner's Manual

    by Einat Peled and Diane Davis

    PSYCHOTHERAPY WITH SEXUALLY ABUSED BOYS. An Integrated Approach

    by William N. Friedrich

    CONFRONTING ABUSIVE BELIEFS: Group Treatment for Abusive Men

    by Mary Nõmme Russell

    TREATMENT STRATEGIES FOR ABUSED CHILDREN: From Victim to Survivorb

    by Cheryl L. Karp and Traci L. Butler

    GROUP TREATMENT FOR ADULT SURVIVORS OF ABUSE: A Manual for Practitioners

    by Laura Pistone Webb and James Leehan

    WORKING WITH CHILD ABUSE AND NEGLECT: A Primer

    by Vernon R. Wiehe

    TREATING SEXUALLY ABUSED CHILDREN AND THEIR NONOFFENDING PARENTS: A Cognitive Behavioral Approach

    by Esther Deblinger and Anne Hope Heflin

    HEARING THE INTERNAL TRAUMA: Working With Children and Adolescents Who Have Been Sexually Abused

    by Sandra Wieland

    PREPARING AND PRESENTING EXPERT TESTIMONY IN CHILD ABUSE LITIGATION: A Guide for Expert Witnesses and Attorneys

    by Paul Stern

    TREATMENT STRATEGIES FOR ABUSED ADOLESCENTS: From Victim to Survivor

    by Cheryl L. Karp, Traci L. Butler, and Sage C. Bergstrom

    HOMICIDE: THE HIDDEN VICTIMS—A Guide for Professionals

    by Deborah Spungen

    TECHNIQUES AND ISSUES IN ABUSE-FOCUSED THERAPY: Addressing the Internal Trauma

    by Sandra Wieland

    Copyright

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    Dedication

    For Willie and Eric

    You're the greatest!

    Also for David L. Corwin, M.D., a pioneer in child protection, and the guy who got me started in this field

    Last, but by no means least, this book is for Lucy Berliner, M.S.W., friend, mentor, counselor, inspiration, and very cool woman

  • Analysis of Problems

    Sally's Case (Chapter 3)

    The question in Sally's case is, If you were Sally's teacher, would you file a report with CPS? I hope you aren't looking for “the answer” because I don't have it. It seems to me that reasonable minds can differ in Sally's case. But you say, “Wait a minute, John, you are the author! You owe me an answer.” All right, all right, if you insist: If I were Sally's teacher, I would not report. For me, the evidence does not rise to the level of reasonable suspicion. I don't see reasonable suspicion of maltreatment. Sally's parents are locked in a bitter divorce, and Sally's sadness and withdrawal seem like a normal reaction to an acrimonious divorce. (See Chapter 7 for discussion of the meaning of various symptoms as evidence of sexual abuse.) As for the kissing episode with Eric, I don't know whether Sally initiated the kissing or whether it was Eric's idea. It seems clear that Sally is suffering, and I'm pretty sure she and her parents need help, but I don't think a report to child protective services is mandated.

    What would I do? I would take the advice of Kalichman (1993):

    If an examination of the indicators leading to the suspicion is inconclusive and the reportability of the situation remains ambiguous, the professional could seek consultation with a colleague, a fellow mandated reporter who might not necessarily be of the same professional background, (p. 156)

    In addition, I would consult with the school psychologist and my principal to brainstorm ways to help this troubled little girl and her parents. Finally, I would keep my antenna up.

    Bill's Confession (Chapter 3)

    What about Bill? Bill made a clear confession of child sexual abuse. Ordinarily, there would be no doubt about the duty to report. If the victim were still a child, or if there were evidence that other children are at risk, reporting would be obvious. But the abuse happened 8 years ago, and the victim is now an adult. Bill says it only happened once. There is no indication that Bill is molesting other children. On the other hand, Bill is fantasizing about the 8-year-old molestation. He can't get it out of his mind. He's lonely and depressed. Psychologically, Bill may be vulnerable to relapse.

    So what is the answer in Bill's case? Again, I'm not sure. The reporting laws generally don't place a time limit on reporting. The fact that the abuse happened 8 years ago does not necessarily eliminate the duty to report. Kalichman (1993) advises that “mandated reporters facing difficult reporting decisions can always contact a child protection worker and request feedback on a case before reporting to verify that particular indicators constitute a reportable situation” (p. 156).

    Commonwealth V. Spring (Chapter 7)

    The facts in Commonwealth v. Spring make a fairly strong case for admitting Dr. Turner's testimony as substantive evidence of sexual abuse. The following factors support admissibility of Dr. Turner's testimony:

    • Dr. Turner is well qualified.
    • Post-traumatic stress disorder is a recognized syndrome seen in sexually abused children.
    • The child's depression, nightmares, fear, and withdrawal support the diagnosis of sexual abuse, although such symptoms in isolation would not suffice for a diagnosis.
    • The child's disclosure to her mother is typical of sexually abused children and demonstrates detailed knowledge of fellatio and ejaculation. Barring some other source of this knowledge, the child's statement supports the doctor's diagnosis.
    • The child describes the progressive nature of her abuse. This pattern is common in incest cases.

    As discussed in Chapter 7, courts in the United States differ on the admissibility of expert testimony offered as substantive evidence. Some courts allow such testimony, others reject it. A third group of courts subject such testimony to the special admissibility test for novel scientific evidence.

    Expert testimony such as that of Dr. Turner is more likely to be allowed in civil than in criminal cases. Thus, a judge might allow Dr. Turner's testimony in juvenile or family court but not permit the testimony in a criminal trial.

    Commonwealth v. Milton (Chapter 7)

    It seems clear that Dr. Friedrich's testimony should be rejected. First, child sexual abuse accommodation syndrome (CSAAS) is not a diagnosis, and CSAAS does not detect sexual abuse. Dr. Friedrich clearly does not understand CSAAS. Moreover, there is no child sexual abuse syndrome. Putting these rather serious shortcomings aside, the evidence in Milton is simply too weak to support a conclusion that sexual abuse occurred. Melissa's nightmares tell us little. The child's statements “Where's my dick?” and “That's my tits” seem innocuous. The other behaviors—resistance to diaper changes, emerging negativism, and separation anxiety—are unremarkable. The child's statement “Daddy hurt 'gina” is too ambiguous to have meaning. Finally, the hair in the diaper adds little. The total picture may raise concern, but the evidence does not support Dr. Friedrich's opinion.

    Smith v. Allred and Jones (Chapter 9)

    This hypothetical case is based on the facts of a real case: Thomason v. SCAN Volunteer Services (1996). In Thomason, the court ruled in favor of the social workers. Although the court felt that the social workers should have conducted a more thorough investigation before removing Anthony, the court nevertheless ruled that the removal did not violate the Smiths' constitutional rights. Because the removal did not violate the Smiths' rights, there was no need for immunity.

    The Smiths also charged that Jones violated their rights by filing a petition in juvenile court and supporting the petition with a false affidavit. On these matters, the Court ruled (a) that Jones had absolute witness immunity for filing the affidavit and (b) that Jones enjoyed absolute prosecutorial immunity for filing the petition in juvenile court.

    The court's decision is instructive, and is quoted in part below:

    We have little difficulty in holding that defendants, upon receiving the [letter from Dr. Denodio], formed a reasonable suspicion of abuse which would justify some degree of interference with plaintiffs' rights as the parents of Anthony.

    The difficulty in the present case is not whether such a reasonable suspicion can be found, but rather, whether the actions taken by defendants and the resulting disruption to plaintiffs' familial relations with Anthony were so disproportionate under the circumstances as to rise to the level of a constitutional deprivation. … The evidence demonstrates that, upon receiving [Dr. Denodio's letter, Jones] proceeded to plaintiffs' residence with the intent to remove Anthony from the plaintiffs' home without so much as a telephone call [to the doctor] to verify the source of the [letter]. Moreover, without even reviewing the purported evidence of abuse in [CPS's] possession, [Jones] appeared at plaintiffs' doorstep and inaccurately asserted to [the mother] that [CPS] had “received a report [that] her child was being smothered and that she was the perpetrator.” Finally, in seeking and obtaining an ex parte protective custody order from the [juvenile] court, [Jones] submitted a signed affidavit that arguably mischaracter-ized [Dr. Denodio's letter] and exaggerated the strength of defendants' evidence of abuse.

    Nevertheless, while we recognize that plaintiffs are justified in feeling that more background investigation could have been done and that [Jones] handled the initial encounter with [the mother] in an unprofessional manner, we hold that plaintiff's constitutional rights were not violated as a result of the removal of Anthony from their home.

    In the child abuse context, the abstract substantive due process right to familial integrity must be continually subjected to “a balancing test which weighs the interest of the parent against the interests of the child.” In the present case, the constitutional inquiry requires weighing the interest of plaintiffs not to have the state physically remove their eight-month-old child from their home against the state's interests in immediately removing the child from a potentially life-threatening abusive home setting for medical evaluation and protection. We recognize that the parents' private interest in this type of acutely sensitive case is “of the highest order.” We also recognize the vital importance of curbing overzealous suspicion and intervention on the part of health care professionals and government officials, particularly where such overzealousness may have the effect of discouraging parents or caretakers from communicating with doctors or seeking appropriate medical attention for children with real or potentially life-threatening conditions. The consequences of such a chilling effect could be devastating. Our holding today is therefore limited to the facts of this case. Where a treating physician has clearly expressed his or her reasonable suspicion that life-threatening abuse is occurring in the home, the interest of the child (as shared by the state as parens patriae) in being removed from that home setting to a safe and neutral environment outweighs the parents' private interest in familial integrity as a matter of law. (pp. 1371-1373)

    Appendix A: American Professional Society on the abuse of Children, Practice Guidelines, Use of Anatomical Dolls in Child Sexual abuse Assessments

    I. Uses and Limitations of Guidelines

    These Guidelines have been developed to reflect current knowledge and generally accepted practice concerning the use of anatomical dolls in interviewing children during assessments of suspected child sexual abuse. The Guidelines are offered to encourage appropriate use of anatomical dolls and to provide direction in the development of training for professionals. The Guidelines are not intended to establish a legal standard of care or a rigid standard of practice to which professionals are expected to adhere. Interviewers must have the flexibility to exercise judgment in individual cases. Laws and local customs may influence accepted methods in a given community. Professionals should be knowledgeable about various constraints on practice and prepared to justify their decisions about particular practices in specific cases. As experience and scientific knowledge expand, further revision of these Guidelines is expected.

    These Guidelines apply to the use of anatomical dolls in investigative and diagnostic interviews of children in cases of alleged or suspected child sexual abuse. Such interviews are designed to determine whether an allegation is likely true, and if so, the nature of the abuse. Investigative interviews are typically conducted by child protective services and law enforcement professionals and by child interview specialists in specialized child abuse programs. Diagnostic interviews are typically conducted by mental health or health care professionals as a part of psychological or medical evaluations (American Medical Association, 1985). Diagnostic interviews often go beyond the focus of investigative interviews in also assessing the child's psychological status and the possible need for psychological treatment.

    These Guidelines are not designed to address the use of anatomical dolls in psychotherapy. Furthermore, these Guidelines do not address the broad issue of questioning techniques during investigative or diagnostic interviews. These Guidelines have the narrower purpose of providing direction on the use of dolls as an adjunct to the questioning process. It is also not the purpose of these Guidelines to provide a comprehensive discussion of the clinical and empirical rationale for the use of anatomical dolls in child sexual abuse assessments.

    II. Introduction

    Anatomical dolls are widely used as interview aids by professionals involved in the investigation and evaluation of child sexual abuse (Boat & Everson, 1988a; Conte, Sorenson, Fogarty, & Dalla Rosa, 1991; Kendall-Tackett & Watson, 1992). Nevertheless, concern has been expressed about possible harm through the use of anatomical dolls in this context. One concern is that anatomical dolls may suggest sexual material, encouraging false reports from non-abused children. Another is that the dolls may be overstimulating or even traumatizing to non-abused children. Another is that the dolls may be overstimulating or even traumatizing to non-abused children by introducing them prematurely to sexual ideas and body parts. A final concern is that interviewers using the dolls may be poorly trained and overzealous in their search for sexual abuse, eliciting unreliable, if not erroneous, evidence of abuse.

    Research does not support the concern that anatomical dolls are inherently too suggestive or sexually stimulating (Everson & Boat, 1994). Followup interviews of parents whose young children had previously been exposed to anatomical dolls do not support the concern that the dolls are traumatizing to non-abused children or may induce them to become preoccupied with sexual issues (Boat, Everson, & Holland, 1990; Bruck, Ceci, Francoeur, & Renick, 1995; Dawson, Vaughn, & Wagner, 1992) Research suggests that the level of training among interviewers using the dolls has increased substantially over the last several years (Boat & Everson, 1988a; Kendall-Tackett & Watson, 1992). The actual skill level of interviewers, however, has only recently become the focus of systematic study and empirical findings on this topic are still limited (Boat & Everson, 1995).

    When used by a knowledgeable and experienced professional, anatomical dolls can be an effective tool to aid in interviewing children to determine (1) whether an allegation of sexual abuse is likely true, and (2) if so, the nature of the abuse. Anatomical dolls are, however, only one of many useful interview tools (e.g., drawing materials, puppets, anatomical drawings) and cannot take the place of sound, child-sensitive interview skills and reasoned clinical judgment. Professionals should be able to describe how the dolls were used in the particular case and how this use conforms to accepted practice (Myers & White, 1989). Professionals should also be familiar with current research on the dolls.

    III. Summary of Research Findings
    • Suggestibility
      • The majority of available research does not support the position that the dolls are inherently too suggestive and overly stimulating to be useful in sexual abuse investigations and evaluations (see review by Everson & Boat, 1994; Everson & Boat, 1990). Specifically, there is little empirical evidence that exposure to the dolls induces non-abused, sexually naive children to have sexual fantasies and to engage in sex play that is likely to be misinterpreted as evidence of sexual abuse.
      • Although analogue studies of children's memory and suggestibility find children four and younger more suggestible than older ones (see review by Ceci & Bruck, 1993), anatomical dolls have not generally been found to be a significant source of increased suggestibility and recall error. Three studies using anatomical dolls as interview aids with children in the 3- to 7-year old range have found that the dolls increased recall accuracy with little or no increase in false reports of genital touching (Katz, Schonfeld, Carter, Leventhal, & Cicchetti, 1995; Saywitz, Goodman, Nicholas, & Moan, 1991; Steward & Steward, in press). In contrast, one study reported high rates of false assertions and false denials of genital touching among children under age 3-1/2 years when the dolls were used as interview aids in conjunction with direct, leading and misleading questions (Bruck et al., 1995).
    • Interpreting Behavior with Dolls

      Young children suspected or known to be sexually abused are statistically more likely than presumably non-abused children to engage in explicit sexualized interactions with dolls. However, many victims of sexual abuse do not display such behavior, and some non-abused children may display such behavior (White, Strom, Santilli, & Halpin, 1986; Jampole & Weber, 1987; August & Forman, 1989). Following are empirical findings that provide some guidance for interpreting sexual behavior with the dolls:

      • Explicit sexual positioning of dolls (e.g., penile insertion in vaginal, oral, and anal openings) is uncommon among non-referred, presumably non-abused young children (see review by Everson & Boat, 1990). When allowed to manipulate the dolls, especially in the absence of adults, a small percentage of presumably non-abused children demonstrate explicit sexual intercourse between dolls or, more rarely, attempt to enact apparent sexual acts between themselves and a doll. Such behavior with the dolls appears to be related to prior sexual exposure (Glaser & Collins, 1989; Everson & Boat, 1990) and to age, gender, socioeconomic status, and possibly race, with four— and five-year-old boys from lower socioeconomic status families somewhat more likely to enact explicit sexual acts with dolls than younger children, girls, or children from higher socioeconomic status families (Boat & Everson, 1994; Everson & Boat, 1990). Therefore, while explicit demonstrations of sexual intercourse with anatomical dolls always deserve further exploration, such activities among younger children and children without known prior sexual exposure are of particular concern.
      • Among non-referred, presumably non-abused children, mouthing or sucking a dolls' penis is very rare prior to about age four and infrequent after age four (Sivan, Schor, Koeppl, & Noble, 1988; Glaser & Collins, 1989; Everson & Boat, 1990). This finding suggests that penises on dolls do not encourage most young children to seek oral gratification by sucking them. Sucking a doll's penis therefore should raise serious concerns about possible prior sexual exposure.
      • When a young child's positioning of the dolls indicates detailed knowledge of the mechanics of sexual acts, the probability of sexual abuse is increased, and further investigation of the source of the child's sexual knowledge is warranted. This is especially true for children under approximately four years of age and for children displaying knowledge of oral and anal intercourse (Everson & Boat, 1990).
      • Manual exploration of a doll's genitalia, including inserting a finger into a doll's vaginal or anal openings, is fairly common behavior among young, presumably non-abused children (Boat & Everson, 1994; Glaser & Collins, 1989). Such behavior is likely to be more concerning if it is accompanied by distress reactions (e.g., anxiety, fear), behavioral regression, or displays of anger and aggression (Gordon, Schroeder, & Abrams, 1990a, 1990b), or by obsessive repetition (Terr, 1981).
    • the Efficacy of Anatomical Dolls
      • When compared to reliance solely on verbal communication, the use of anatomical dolls has been shown to enhance children's ability to recall and describe events (Katz et al., 1995; Leventhal, Hamilton, Rekedal, Tebano-Micci, & Eyster, 1989; Saywitz et al., 1991; Steward & Steward, 1995). However, the dolls may not necessarily be superior to other interview aids such as anatomical drawings or regular dolls (Britton & O'Keefe, 1991; Goodman & Aman, 1990; Steward & Steward, in press). Additional research is needed, especially examining the various functions anatomical dolls can serve in the assessment process among children of different developmental levels.
    IV. Appropriate Uses
    • No predetermined amount of time must expire before dolls are introduced, nor must a predetermined number or type of questions be asked before using dolls. Every child is unique and interviewers should use their judgement to determine when, and if, dolls may be useful.
    • If possible, the interviewer should be aware of the extent and nature of the child's possible prior exposure to anatomical dolls. This information is important for assessing the likely usefulness of the dolls in the current interview and for better understanding the child's reaction to and behavior with the dolls. Such information is especially important in cases in which children may have had multiple, prior doll interviews or may have been exposed to the dolls in a play therapy format in which fantasy play was encouraged.
    • The number of dolls presented (e.g., individual dolls vs. set of two, three, or four) depends upon their specific use in the interview.
    • When sexual abuse is suspected, dolls can be used as part of the assessment process in the following ways (Everson & Boat, 1994):
      • Anatomical Model: The dolls can function as anatomical models for assessing a child's labels for parts of the body, understanding of bodily functions, and possible precocious knowledge of the mechanics of sexual acts. The interviewer may point to sexual and non-sexual body parts and ask questions like, “What do you call this part?” “What is it for?” and, “Is it for anything else?”

        The dolls can also serve as visual aids for direct inquiries about the child's personal experiences with private parts. This may include questions such as, “Do you have one (vagina)?,” “Has anything ever happened to yours?,” and “Has it ever been hurt?”

        If the child uses a non-standard term, such as “kitty cat,” to refer to a body part, the dolls can be used to clarify the child's meaning. It is appropriate to use the child's terms for body parts.

      • Demonstration Aid: The dolls can serve as props to enable children to “show” rather than “tell” what happened, especially when limited verbal skills or emotional issues, such as fear of telling or embarrassment about discussing sexual activities, interfere with direct verbal description. This function of the dolls also includes their use to clarify a child's statement after a disclosure of abuse has been made. Whether or not a child experiences difficulty communicating about sexual abuse, dolls are sometimes useful to confirm an interviewer's understanding of a child's description of abuse and to reduce the likelihood of miscommunication between the child and the interviewer.

        Interviewers should be cautious in using anatomical dolls as demonstration aids with children under approximately age 31/2 years. This caution is based on questions about the cognitive ability of young preschoolers to use dolls to represent themselves in behavioral reenactments (DeLoache, 1995) and on concerns about the potential of the dolls to distract very young children (e.g., Goodman & Aman, 1990). These concerns do not preclude other uses of the dolls with young children. Furthermore, young children may use an anatomical doll to represent someone other than themselves and may, for example, demonstrate with a doll on their own bodies what they experienced.

      • Memory Stimulus: Exposure to the dolls, and especially to such features as secondary sexual characteristics, genitalia, and articles of clothing, may be useful in stimulating or triggering a child's recall of specific events of a sexual nature. Supporting this use is research suggesting that props and concrete cues may be more effective in prompting memories in young children than are verbal cues or questions (e.g., Nelson & Ross, 1980). To encourage recall, it may be appropriate for the interviewer to ask questions such as, “Have you seen one (penis)?” or “Do the dolls help you remember anything else that happened?”
      • Screening Tool: This function, which sometimes overlaps with the Memory Stimulus use, is based on the premise that exposure to the dolls in a non-threatening setting may provide an opportunity for the child to spontaneously reveal his/her sexual interests, concerns, or knowledge. Typically, the child is given the opportunity freely to examine and manipulate the dolls while the interviewer observes the child's play, reaction, and remarks. The interviewer can be either present or absent (observing through a one-way mirror) during this time, although children are likely to be less inhibited in their manipulations of the dolls without an adult present. After a period of uninterrupted manipulation and exploration of the dolls without an adult present, the interviewer asks follow-up questions about the child's behavior with, or reaction to, the dolls (e.g., behavior, unusual emotional responses, as well as spontaneous “suspicious” statements made by the child [e.g., “Daddy's pee-pee gets big sometimes”] should be the focus of follow-up questions to the child).
      • Icebreaker: The dolls can serve as a conversation starter on the topic of sexuality by focusing the child's attention in a non-threatening, non-leading manner on sexual issues and sexual body parts. This may be especially important in the case of younger children and children with less well developed language skills who may require very direct cuing to understand what, from the universe of possibilities, the interviewer wants the child to talk about (Steward & Steward, in press). Dolls can also be useful in helping a child feel comfortable about talking about body parts, sexuality, etc., and in conveying tacit permission for the child to describe or demonstrate sexual knowledge and experience.

        Sexually abused children are not always able to give a coherent verbal account of sexual abuse for a variety of reasons, including developmental level, language limitations, fear, embarrassment, and guilt. When a child's characteristics allow it, however, interviewers should generally attempt to obtain a verbal description from the child before asking the child to demonstrate with the dolls.

    • Generally accepted practice is to present the dolls clothed, but exceptions exist. For example, it may be appropriate to present the dolls unclothed when they are being used as a demonstration aid with a child who has already indicated that the individuals in his/her account were naked.
    • Depending upon individual child characteristics, anatomical dolls can be appropriately used in interviews with children from a wide age range, including with some adolescents. Some uses, however, such as screening tool and icebreaker, are less common among older children (Boat & Everson, 1995; Kendall-Tackett & Watson, 1992).
    V. Inappropriate Uses
    • The use of anatomical dolls as a diagnostic test for child sexual abuse is not supported by the empirical evidence (Everson & Boat, 1994). Specifically, it is not appropriate to draw definitive conclusions about the likelihood of abuse based solely upon interpretations of a child's behavior with the dolls. There is no known behavior with the dolls that can be considered a definitive marker of sexual abuse in the absence of other factors, such as the child's verbal account or medical evidence (Everson & Boat, 1990; Realmuto, Jensen, & Wescoe, 1990; Boat & Everson, 1994).
    • Interviewers should refrain from making statements that might encourage the child to view the dolls as toys or objects for fantasy play. This includes the use of words such as “play,” “pretend,” or “make believe.” Interviewers should also be cautious in the use of conjecture in questioning with dolls because of the possibility of encouraging fantasy (e.g., “If someone were to touch a girl in a way she didn't like, show me how they would do it.”). The interviewer should consider giving the child the clear admonition that the dolls are used to help talk about and show “things that really happened.”
    • The practice of the interviewer placing the dolls in sexually explicit positions and asking the child to relate the depiction to the child's experience (e.g., “Did this ever happen to you?”) is leading and should be avoided.
    • Like any interview tool or technique, anatomical dolls can be misused. For example, dolls can be used in conjunction with inappropriately suggestive questions. Interviewers should monitor themselves to avoid improperly suggestive use of dolls (White & Quinn, 1988; Quinn, White, & Santilli, 1989).
    VI. Doll Specifications
    • The utility of dolls in the interview process depends in large measure on the presence of certain physical features of the dolls. The following are considered to be important features:
      • Genitalia and breasts that are proportional to body size and appropriate to the gender and age of the given doll.
      • Oral, vaginal, and anal openings that will accommodate the adult male doll's penis.
      • Facial expressions that are at least reasonably attractive and devoid of negative emotions, such as fear or anxiety.
      • A size that can reasonably be manipulated by young children.
      • Sturdy construction that can withstand rough handling.
      • Clothes that can be easily removed.
      • Clothes, including underwear, that are appropriate to the doll's represented age and gender.
    • The impact of the racial features and skin color of the dolls on the child's response has not been empirically examined. Preferred practice is to match the dolls with the race of the child. If it is likely that the alleged perpetrator is a different race from the child, the interviewer should consider presenting dolls of both races or a set of race non-specific dolls with neutral skin tones.
    VII. Training and Skill Level of Interviewers
    • Professionals using dolls should possess the training and/or knowledge and experience required to conduct forensic investigative or diagnostic interviews with children suspected of having been sexually abused. Refer to the APSAC Guidelines for Psychosocial Evaluation of Suspected Sexual Abuse in Young Children for general requirements regarding training, skill level, and supervision for interviewers.
    • Before using the dolls, the interviewer should acquire the requisite skills through familiarity with the research literature and applicable guidelines, consultation with colleagues, and/or clinical supervision. The interviewer should be familiar with developmental issues in the use of the dolls, appropriate and inappropriate uses of the dolls, and potential problems caused by using leading questions or other suggestive techniques with the dolls.
    • A formal, structured protocol detailing the use of dolls in interviews is not required and, given the state of our knowledge and the need for flexibility in individual cases, rigid protocols are probably not advisable. However, these guidelines and other general guidelines on the use of anatomical dolls in sexual abuse evaluations are available and may be helpful (e.g., Boat & Everson, 1986, 1988b; Levy, Kalinowski, Markovic, Pittman, & Ahart, 1991; Morgan, 1995; White, 1991).
    VIII. Documentation
    • Detailed documentation of the interview process should be provided. Because of the potential subtlety and richness of the child's behavior with anatomical dolls, videotape recording of the interview may offer advantages. If videotaping is impracticable or contraindicated, the interviewer's questions and the child's verbal, non-verbal, and affective responses regarding sexual abuse allegations or concerns should be documented. This can be done in writing or using a combination of audiotape and written notes.
    • It is desirable to prepare a verbatim record of all portions of the interview specifically relating to the issue of possible sexual abuse. This includes a description of the child's behavior with dolls, including the child's positioning of the dolls, critical verbal statements, and any verbal, nonverbal, or affective behavior with the dolls, such as avoidance, anxiety, fear, anger, or regression.
    IX. Conclusions
    • Anatomical dolls are a useful and accepted tool for investigative and diagnostic interviews of children in cases of possible abuse.
    • Professionals using anatomical dolls in child sexual abuse assessments should be knowledgeable and experienced in conducting forensically sound interviews with children and in the specific use of anatomical dolls.
    • Interviewers should be prepared to describe how they used anatomical dolls in each specific case and how this use conforms to accepted practice.
    • Interviewers should be aware of the limitations in the use of anatomical dolls. Specifically, anatomical dolls should not be considered to be a diagnostic test of sexual abuse, nor be over-emphasized in the assessment process to the exclusion of broader interview techniques.
    References
    American Medical Association. (1985). AMA diagnostic and treatment guidelines concerning child abuse and neglect. Journal of the American Medical Association, 254, 796–803. http://dx.doi.org/10.1001/jama.1985.03360060098034
    American Professional Society on the Abuse of Children. (1990) Guidelines for psycho social evaluation of suspected sexual abuse in young children. Chicago: Author.
    August, R. L., & Forman, B. D. (1989). A comparison of sexually and non-sexually abused children's behavioral responses to anatomically correct dolls. Child Psychiatry and Human Development, 20, 39–47. http://dx.doi.org/10.1007/BF00706956
    Boat, B. W., & Everson, M. D. (1995, April). Interview errors in the use of anatomical dolls in child protective services investigations. Paper presented at the Biennial Conference of the Society for Research in Child Development
    Boat, B. W., & Everson, M. D. (1994) Anatomical doll exploration among non-referred children: Comparisons by age, gender, race, and socioeconomic status. Child Abuse & Neglect, 18, 139–153. http://dx.doi.org/10.1016/0145-2134%2894%2990116-3
    Boat, B. W., & Everson, M. D. (1988a). Use of anatomical dolls among professionals in sexual abuse evaluation. Child Abuse & Neglect, 12, 171–179. http://dx.doi.org/10.1016/0145-2134%2888%2990025-7
    Boat, B. W., & Everson, M. D. (1988b). Interviewing young children with anatomical dolls. Child Welfare, 67, 337–351.
    Boat, B. W., & Everson, M. D. (1986) Using anatomical dolls: Guidelines for interviewing young children in sexual abuse investigations. Chapel Hill: University of North Carolina.
    Britton, H., & O'Keefe, W. A. (1991). Use of anatomical dolls in the sexual abuse interview. Child Abuse & Neglect, 15, 567–573. http://dx.doi.org/10.1016/0145-2134%2891%2990040-K
    Bruck, M., Ceci, S., Francoeur, D., & Renick, A. (1995) Anatomical detailed dolls do not facilitate preschoolers' reports of a pediatric examination involving genital touching. Journal of Experimental Psychology: Applied, 1, 95–109. http://dx.doi.org/10.1037/1076-898X.1.2.95
    Ceci, S. J., & Bruck, M. (1993). Suggestibility of the child witness: A historical review and synthesis. Psychological Bulletin, 113, 403–439. http://dx.doi.org/10.1037/0033-2909.113.3.403
    Conte, J. R., Sorenson, E., Fogarty, L., & Dalla Rosa, J. (1991). Evaluating children's reports of sexual abuse: Results from a survey of professionals. American journal of Orthopsychiatry, 61, 428–437. http://dx.doi.org/10.1037/h0079264
    DeLoache, J. (1995). The use of dolls in interviewing young children. In M. S.Zaragoza, J. R.Graham, G. H.Hall, R.Hirschman, & Y. S.Ben-Porath (Eds.), Memory and testimony in the child witness. Newbury Park, CA: Sage.
    Everson, M. D., & Boat, B. W. (1990). Sexualized doll play among young children: Implications for the use of anatomical dolls in sexual abuse evaluations. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 736–742. http://dx.doi.org/10.1097/00004583-199009000-00010
    Everson, M. D., & Boat, B. W. (1994). Putting the anatomical doll controversy in perspective: An examination of the major uses and criticisms of the dolls in child sexual abuse evaluations. Child Abuse & Neglect, 18, 113–129. http://dx.doi.org/10.1016/0145-2134%2894%2990114-7
    Glaser, D., & Collins, C. (1989). The response of young non-sexually abused children to anatomically correct dolls. Journal of Child Psychology and Psychiatry, 30, 547–560. http://dx.doi.org/10.1111/j.1469-7610.1989.tb00267.x
    Goodman, G., & Aman, C. (1990). Children's use of anatomically correct dolls to report an event. Child Development, 61, 1859–1871. http://dx.doi.org/10.2307/1130842
    Gordon, B. N., Schroeder, C, & Abrams, J. M. (1990a). Children's knowledge of sexuality: A comparison of sexually abused and nonabused children. American Journal of Orthopsychiatry, 60, 250–257. http://dx.doi.org/10.1037/h0079177
    Gordon, B. N., Schroeder, C., & Abrams, J. M. (1990b). Age and social class differences in children's knowledge of sexuality. Journal of Clinical Child Physiology, 19, 33–43.
    Jampole, L., & Weber, M. K. (1987). An assessment of the behavior of sexually abused and non-sexually abused children with anatomically correct dolls. Child Abuse & Neglect, 11, 187–192. http://dx.doi.org/10.1016/0145-2134%2887%2990057-3
    Katz, S., Schonfeld, D. J., Carter, A. S., Leventhal, J. M., & Cicchetti, D. V. (1995). The accuracy of children's reports with anatomically correct dolls. Developmental and Behavioral Pediatrics, 16(2), 71–76. http://dx.doi.org/10.1097/00004703-199504000-00001
    Kendall-Tackett, K. A., & Watson, M. W. (1992) Use of anatomical dolls by Boston-area professionals. Child Abuse & Neglect, 16, 423–428. http://dx.doi.org/10.1016/0145-2134%2892%2990051-R
    Koocher, G. P., Goodman, G. S., White, S., Friedrich, W. N., Sivan, A. B., & Reynolds, C. R. (1995M). Psychological science and the use of anatomically detailed dolls in child sexual abuse assessments: Final report of the American Psychological Association Anatomical Doll Task Force. Psychological Bulletin, 118, 2. http://dx.doi.org/10.1037/0033-2909.118.2.199
    Leventhal, J. M., Hamilton, J., Rekedal, S., Tebano-Micci, A., & Eyster, C. (1989). Anatomically correct dolls used in interviews of young children suspected of having been sexually abused. Pediatrics, 84, 900–906.
    Levy, J., Kalinowski, N., Markovic, J., Pittman, M., & Ahart, S. (1991) Victim-sensitive interviewing in child sexual abuse. Chicago: Mount Sinai Hospital Medical Center.
    Morgan, M. (1995). How to interview sexual abuse victimsNewbury Park, CA: Sage.
    Myers, J. E. B., & White, S. (1989). Dolls in court?APSAC Advisor, 2(3), 5–6.
    Nelson, K., & Ross, G. (1980) The generalities and specifics of long-term memory in infants and young children. New Directions for Child Development, 10, 87–101. http://dx.doi.org/10.1002/cd.23219801008
    Realmuto, G. M., Jensen, J. B., & Wescoe, S. (1990). Specificity and sensitivity of sexually anatomically correct dolls in substantiating abuse: A pilot study. Journal of the American Academy of Child and Adolescent Psychiatry, 19, 743–746. http://dx.doi.org/10.1097/00004583-199009000-00011
    Sivan, A., Schor, D., Koeppl, G. K., & Noble, L. D. (1988). Interactions of normal children with anatomically correct dolls. Child Abuse & Neglect, 12, 295–304. http://dx.doi.org/10.1016/0145-2134%2888%2990042-7
    Steward, M., & Steward, D. (In press). Interviewing young children about body touch and handling. Monograph Series for the Society for Research in Child Development.
    Terr, L. (1981) Forbidden games: Post-traumatic child's play. Journal of the American Academy of Child Psychiatry, 20, 740–759. http://dx.doi.org/10.1097/00004583-198102000-00006
    White, S. (1991). Using anatomically detailed dolls in interviewing preschoolers. In C.Schaefer, K.Gitlund, & D.Sandgrund (Eds.), Play diagnosis and assessment (pp. 317–330). New York: John Wiley.
    White, S., & Quinn, K. (1988). Investigatory independence in child sexual abuse evaluations: Conceptual considerations. Bulletin of the American Academy of Psychiatry and Law, 16, 269–278.
    White, S., Strom, G., Santilli, G., & Halpin, B. (1986) Interviewing young children with anatomically correct dolls. Child Abuse & Neglect, 19, 519–529. http://dx.doi.org/10.1016/0145-2134%2886%2990057-8
    Additional Resources on Interviewing
    American Professional Society on the Abuse of Children. (1990). APSAC Advisor, 3(2). (Special issue dedicated to child interviewing).
    Faller, K. C. (1995). APSAC study guide: Interviewing children suspected of having been sexually abused. Newbury Park, CA: Sage.
    Faller, K. C. (1990). Understanding child sexual maltreatment. Newbury Park, CA: Sage Publications.
    Garbarino, J., & Stott, F. M. (1990). What children can tell us. San Francisco: Jossey-Bass.
    Jones, D. P. H., & McQuiston, M. (1985). Interviewing the sexually abused child. Denver, CO: C. Henry Kempe National Center for the Prevention and Treatment of Child Abuse and Neglect.
    MacFarlane, K., & Waterman, J. (1986)Sexual abuse of young children. New York: Guilford.
    Myers, J. E. B. (1992). Legal issues in child abuse and neglect practice. Newbury Park, CA: Sage. http://dx.doi.org/10.4135/9781452225562
    Perry, N. W., & Wrightsman, L. S. (1991)The child witness. Newbury Park, CA: Sage.
    Acknowledgments

    These Guidelines are the product of APSAC's Task Force on the Use of Anatomical Dolls in Child Sexual Abuse Assessments chaired by Mark D. Everson, Ph.D., John E. B. Myers, J.D., and Sue White, Ph.D. The first draft was published for comment in The APSAC Advisor in Spring, 1993. In addition, four open Task Force meetings were held to request input on early drafts of the Guidelines: at the San Diego Conference on Responding to Child Maltreatment in January 1993; at the First National APSAC Colloquium in Chicago, June 1993; at the Second National APSAC Colloquium in Cambridge, Massachusetts, May 1994; and at the San Diego Conference on Responding to Child Maltreatment in January, 1995. The current version of the Guidelines reflects the experience and expertise of a large number of APSAC members as well as the APSAC Board of Directors. We gratefully acknowledge the many individuals who contributed their time and expertise to make these Guidelines possible and especially to Kathleen Coulborn Faller, Ph.D., A.C.S.W.

    These Guidelines will be updated periodically. Any comments or suggestions should be directed to Mark E. Everson, Ph.D., through APSAC, 407 South Dearborn, Suite 1300, Chicago, IL 60605.

    Appendix B: Sample Protective Order for Videotapes of Investigative Interviews on Child abuse

    Protective Order
    • For purposes of this order, tape(s) means any videotape or audiotape of a child.
    • Tapes may be viewed only by parties, their counsel and their counsel's employees, investigators, experts for the purpose of prosecuting or defending this action, and the child's guardian ad litem.
    • No tape, or the substance of any portion thereof, shall be divulged by any person subject to this protective order to any other person, except as necessary for the trial or preparation for trial in this proceeding, and such information shall be used only for purposes of the trial and preparation for trial herein.
    • No person shall be granted access to the tape, any transcription thereof, or the substance of any portion thereof unless that person has first signed an agreement in writing that the person has received and read a copy of this protective order, that the person submits to the Court's jurisdiction with respect to the protective order, and that the person will be subject to the Court's contempt powers for any violation of the protective order.
    • Each of the tape cassettes and transcripts thereof available to the parties, their attorneys and respective agents shall bear the following legend:

      THISOBJECT OR DOCUMENT AND THE CONTENTS THEREOF IS SUBJECT TO A PROTECTIVE ORDER ENTERED BY THE COURT IN STATE V._____. CASE NUMBER_____ THIS OBJECT OR DOCUMENT AND THE CONTENTS THEREOF MAY NOT BE EXAMINED, INSPECTED, READ, VIEWED, OR COPIED BY ANY PERSON, OR DISCLOSED TO ANY PERSON, EXCEPT AS PROVIDED IN THE PROTECTIVE ORDER. ANY PERSON VIOLATING SUCH PROTECTIVE ORDER IS SUBJECT TO THE FULL CONTEMPT POWER OF THE COURT AND MAY BE GUILTY OF A CRIME.

    • Unless otherwise provided by order of this Court, no additional copies of the tape or any portion of the tape shall be made without prior court order.
    • The tape shall not be given, loaned, sold, or shown to any person except as provided by this order or by subsequent order of this Court.
    • Upon final disposition of this case any and all copies of the tape and any transcripts thereof shall be returned to the Court for safekeeping, except those tapes booked into and kept as evidence by the investigating law enforcement agencies. Those materials subject to this order so kept by any law enforcement agency shall remain subject to this order and those materials shall remain secured in evidence in accordance with the agency's policies and procedures.
    • This protective order shall remain in full force and effect until further order of this Court.

    Appendix C: American Professional Society on the Abuse of Children, Guidelines for Psychosocial Evaluation of Suspected Sexual abuse in Young Children

    Statement of Purpose

    These Guidelines for mental health professionals reflect current knowledge and an emerging consensus about the psychosocial evaluation of suspected sexual abuse in children. They are not intended as a standard of practice to which practitioners are expected to adhere in all cases. Evaluators must have the flexibility to exercise clinical judgment in individual cases. Laws and local customs may also influence the accepted method in a given community. Practitioners must be prepared to justify their decisions about particular practices in specific cases. As experience and scientific knowledge expand, further refinement and revision of these Guidelines are expected.

    These Guidelines are specific to psychosocial evaluations. Psychosocial evaluations are a systematic process of gathering information and forming professional opinions about the source and meaning of statements, behavior, and other evidence that are the basis of concern about possible sexual abuse. The results of such evaluations may be used to direct treatment planning and to assist in legal decision making.

    Psychosocial evaluators should first establish the purpose of the evaluation and their role in the evaluation process. Psychological evaluations may be conducted for purely clinical reasons or be forensic in nature. These Guidelines pertain to both situations.

    Clinical evaluations may be requested by parents, guardians or other professionals to determine whether there is reason to be concerned about possible abuse. It is also customary for clinicians to precede treatment for the effects of sexual abuse with an assessment of the sexual abuse history.

    Forensic evaluations have the explicit purpose of contributing to legal decision making or legal proceedings. Such evaluations may be requested by parents or guardians, public child protective services (CPS) agencies, attorneys, guardians ad litem (or court appointed special advocates), or other professionals. The results may be used in civil or criminal proceedings. As noted in these Guidelines, forensic evaluations are different from clinical evaluations in generally requiring a different professional stance and additional components.

    In all cases, evaluators should be aware that any interview with a child regarding possible sexual abuse may be subject to scrutiny and have significant implications for legal decision making and the child's safety and well-being.

    Guidelines
    The Evaluator
    • Characteristics
      • The evaluator should possess a graduate level mental health degree in a recognized discipline (e.g., psychiatry, psychology, social work, nursing, child development) or be supervised by a professional with a graduate level degree.
      • The evaluator should have professional experience assessing and treating children and families, and professional experience with sexually abused children. A minimum of two years of professional experience with sexually abused children is expected; three to five years is preferred for forensic evaluators. If the evaluator does not possess such experience, supervision is essential.
      • The evaluator must have had specialized training in child development and child sexual abuse. This training should be documented in terms of formal course work, supervision, or attendance at conferences, seminars, and workshops.
      • The evaluator should be knowledgeable about the dynamics and the emotional and behavioral consequences of sexual abuse experiences. The evaluator should be familiar with the professional literature and with current issues relevant to understanding and evaluating sexual abuse experiences.
      • The evaluator should be familiar with different cultural values and practices that may affect definitions of sexual abuse, child and/or family comfort with the evaluation process, child and/or family willingness to provide complete and accurate information, and the evaluator's own interpretation of responses.
      • If the purpose of the evaluation is forensic, the evaluator should have experience in conducting forensic evaluations and providing expert testimony. If the evaluator does not possess such experience, supervision is essential.
      • The evaluator should approach the evaluation with an open mind to all possible responses from the child and all possible explanations for the concern about sexual abuse. The evaluator should recognize that all sources of information have limitations and may contain inaccuracies. In forming an opinion, the evaluator should consider plausible alternative hypotheses.
    II. Components of the Evaluation
    Protocol
    • A written protocol is not necessary; however, evaluations should ordinarily involve reviewing those materials considered relevant for the type of evaluation; conducting collateral interviews when necessary; establishing rapport; assessing the child's developmental status, cognitive capacity, level of functioning and level of distress; and specifically evaluating the possibility of abuse. The evaluator may use discretion in the order and method of assessment. Forensic evaluations differ from evaluations conducted for purely clinical reasons in that they generally involve reviewing relevant materials and conducting collateral interviews.
    • If information is available prior to the evaluation that meets the respective state's definition of reasonable suspicion for a CPS report, but no CPS report has yet been made, the evaluator should make the report and may choose to defer the evaluation until the CPS investigation has been conducted.
    • When possible, unsupervised contact between the child and the suspected offender should be strongly discouraged during the evaluation process.
    Employer of the Evaluator
    • Evaluation of the child may be conducted at the request of a legal guardian prior to court involvement. When only one parent has requested the evaluation, evaluators should give careful consideration to informing the other parent about the evaluation whether or not that parent is the focus of concern. When the other parent is the focus of concern, that parent is likely to request another evaluation; evaluators should consider whether it would be in the child's best interest to have a mutually agreed upon or court appointed evaluator to avoid unnecessary evaluations.
    • If the evaluation is specifically requested or intended for use in a legal proceeding or a court is already involved, the preferred practice is a court-appointed or mutually agreed upon evaluator of the child. In some circumstances exceptions to this practice are acceptable or are customary practice (e.g., contractual arrangements with child protective services, civil damage suits, when one party refuses to cooperate).
    • Discretion should be used in agreeing to conduct an evaluation of a child when the child has already been evaluated. Additional evaluations should be conducted only if they clearly further the best interests of the child. When a second opinion is required, a review of the records may eliminate the need for re-interviewing the child.
    Number of Evaluators
    • The evaluation may be conducted by a single evaluator or by a team of professionals.
    Collateral Information Gathered as Part of the Evaluation
    • Evaluators may seek and review background materials or conduct interviews as part of the evaluation process. The amount and nature of information reviewed depends on the purpose of the evaluation and the extent to which such information will be helpful in addressing the referral question and understanding the child's presenting problems or concerns. For clinical evaluations, clinical judgment should determine the necessity for additional records, materials, or interviews. Evaluators should request that background material be made available and collateral interviews be permitted for forensic evaluations.
    • The evaluation report should reflect an objective review of collateral information relied upon in the evaluation or opinion forming process.
    Interviewing the Accused or Suspected Individual
    • It is not necessary to interview the accused or suspected individual in order to form an opinion about possible sexual abuse of the child.
    • An interview with or review of the statements from a suspected or accused individual may provide additional relevant information (e.g., alternative explanations, admissions, insight into relationship between child and accused individual).
    • If the accused or suspected individual is a parent who seeks to participate in the evaluation and there are no contraindications (e.g., criminal investigation or charges pending, civil suit), interviewing of the accused or suspected parent should be given strong consideration.
    Releasing Information
    • Suspected abuse should always be reported to authorities as dictated by state law. Except as specified by law, clinical evaluators have no affirmative duty to disclose confidential clinical information.
    • Permission should be obtained from legal guardian(s) to request collateral materials and for release of information about the evaluation to relevant medical or mental health professionals, other professionals (e.g., schoolteachers), and involved legal systems (e.g., CPS, law enforcement, lawyers, courts). Discretion should be used in releasing sensitive individual and family history that does not directly relate to the purpose of the assessment.
    • Feedback about the results of the evaluation should usually be offered to parent(s) or legal guardian(s) and may be offered to the child, except where doing so would not be in the best interests of the child.
    III. Interviewing
    Recording of Interviews
    • Written documentation is the minimum requirement. Verbatim quotation of significant questions and answers is desirable. Forensic evaluations should contain specific documentation of questions and responses (verbal and nonverbal) regarding possible sexual abuse.
    • Audio or video recording may be preferred practice in some communities. Professional preference, logistics, or clinical considerations may contra indicate recording of interviews. Professional discretion is permitted in recording policies and practices.
    • When audio and video recording are used, the child and legal guardian should be informed. It is desirable to obtain assent from the child (when age appropriate) and consent from legal guardian(s).
    Observation of the Interview
    • Professional discretion is permitted in observation policies and practices. Observation of interviews by involved professionals (CPS, law enforcement, etc.) may be indicated if it reduces the need for additional interviews and will not compromise the evaluation process.
    • Observation by non-accused and non-suspected primary caregiver(s) may be indicated for particular clinical reasons; however, great care should be taken that the observation is clinically appropriate, does not unduly distress the child, and does not affect the validity of the evaluation process.
    • If interviews are observed, the child must be informed. It is desirable to obtain assent from the child (when age appropriate) and consent from legal guardian(s).
    Number of Interviews
    • The evaluator determines the number of interviews necessary to address the referral question and assess the child's presenting problems or concerns. This does not imply that all sessions must include specific questioning about possible sexual abuse. The evaluator may decide, based on the individual case circumstances, to adopt a less direct approach and reserve questioning about possible sexual abuse for subsequent interviews. Repeated direct questioning of the child regarding sexual abuse when the child is not reporting or is denying abuse is usually contraindicated.
    • If the child does not report abuse and further direct questioning is judged to be counterproductive, but the evaluator has continuing concerns about the possibility of abuse, the child may be referred for an extended evaluation or therapy that is less directive, but diagnostically focused. Recommendations regarding conditions necessary to insure the child's protection from possible abuse should be made.
    Format of Interview
    • When possible, interviewing the primary caregiver and reviewing other collateral data first to gather background information may facilitate the evaluation process.
    • The child should be seen individually, except when the child refuses to separate from a parent/guardian. Discussion of possible abuse with the child in the presence of the caregiver during evaluation interviews should be avoided except when necessary to elicit information from the child. In such cases, the interview setting should be structured to reduce the possibility of improper influence by the caregiver on the child's behavior or statements.
    • In some cases, joint sessions with the child and the non-accused caregiver or accused or suspected individual might be helpful to obtain information regarding the overall quality of the relationships. Such joint sessions should not be conducted for the purpose of determining whether abuse occurred based on the child's reactions to the participating adult. Joint sessions should not be conducted if they will cause significant distress for the child.
    • Joint sessions with a child and an accused or suspected individual should only be considered when the individual is a parent or primary caregiver. In making a decision about conducting a joint session with a child and the accused or suspected parent, the evaluator should carefully weigh the possibility of gaining valuable information against the significant potential for negative consequences for an abused child and for the evaluation process. A child should never be asked to discuss the possible abuse in front of an accused or suspected parent.
    IV. Child Interview
    General Principles
    • The evaluator should create an atmosphere that enables the child to talk freely, including providing physical surroundings and a climate that facilitates the child's comfort and communication.
    • The evaluator should convey to all parties that no assumptions have been made about whether abuse has occurred.
    • Language and interviewing approach should be developmentally and culturally appropriate.
    • The evaluator should take the time necessary to perform a complete evaluation and should avoid any coercive quality to the interview.
    • Interview procedures may be modified in cases involving very young, minimally verbal children or children with special problems (e.g., developmentally delayed, electively mute, non-native speakers).
    • The difference between the evaluation phase and a treatment phase should be articulated. Under certain circumstances (e.g., disputed custody cases), it may be preferable to obtain agreement from the parties before proceeding with treatment following evaluation.
    Questioning
    • It may be helpful to preface questioning with specific statements designed to reduce misunderstandings during the interview(s), and promote accuracy and completeness.
    • It may be helpful to begin the interview with open-ended questions about neutral topics (e.g., family, school, recent event) so that the child has an opportunity to practice providing free recall responses.
    • Initial substantive questioning should be open-ended and as non-directive as possible to elicit free recall responses. More focused or specific questioning should follow. Once information is provided in response to a specific question, open-ended prompts should again be used.
    • The child should be questioned directly about possible sexual abuse at some point in the evaluation if less directive approaches have not yielded adequate information to answer the referral question.
    • The evaluator may use the form of questions deemed necessary and justified to elicit information on which to base an opinion. Highly specific questioning should only be used when other methods of questioning have failed, when previous information warrants substantial concern, or when the child's developmental level precludes more non-directive approaches. However, responses to these questions should be carefully evaluated and weighed accordingly. Coercive or intimidating questioning is never justified.
    Use of Dolls and other Devices
    • A variety of non-verbal tools may be used to assist young children in communication, including drawings, toys, dollhouses, dolls, puppets, etc. Since such materials have the potential to be distracting or misleading they should be used with care. They are discretionary for older children.
    • Anatomical dolls are accepted interview aids. Evaluators using anatomical dolls should be knowledgeable about the functions they may serve and should conform to accepted practice. (Refer to the APSAC Guidelines on the Use of Anatomical Dolls in Child Sexual Abuse Assessments.)
    • Anatomical dolls should not be used as a diagnostic test for sexual abuse. Definitive conclusions about a history of sexual abuse should not be based solely on interpretation of behavior with the dolls. Unusual behavior with the dolls may suggest further lines of inquiry that should be pursued. The unusual behavior and the responses to further questioning should be noted in the evaluation report.
    • Story books, coloring books or videos that contain explicit descriptions of abuse situations are potentially suggestive and are primarily teaching tools. They are typically not appropriate for evaluation purposes.
    Psychological Testing
    • Formal psychological testing of the child is not necessary for the purpose of proving or disproving a history of sexual abuse.
    • Psychological testing may be useful when the clinician has questions about the child's intellectual or developmental level. Psychological tests can also provide helpful information regarding a child's emotional status and general functioning.
    • Psychological testing of parents is not a routine component of child evaluations. An evaluation that includes assessment of parents may involve psychological tests.
    V. Conclusions/Report
    A. General Principles
    • The evaluation report should document the sources of information and/or data relied on in forming an opinion and making recommendations.
    • The evaluator may state an opinion that abuse did or did not occur, an opinion about the likelihood of the occurrence of abuse or simply provide a description and analysis of the gathered information.
    • Opinions should include supporting information (e.g., the child, parents)/guardian(s) and/or the accused individual's statements, behavior, psychological symptoms). Possible alternative explanations should have been considered. The evaluator should not suggest that mental health professionals have any special ability to detect whether an individual is telling the truth.
    • The evaluation may be inconclusive. If so, the evaluator should cite the information that causes continuing concern but does not enable confirmation or disconfirmation of abuse. If inconclusiveness is due to such problems as missing information or an untimely or poorly-conducted investigation, these obstacles should be clearly noted in tike report.
    • Recommendations should be made regarding therapeutic or environmental interventions to address the child's emotional and behavioral functioning and to ensure the child's safety.
    Acknowledgments

    These Guidelines are the product of APSAC's Task Force on the Psycho-social Evaluation of Suspected Sexual Abuse in Children, chaired by Lucy Berliner, MSW. The initial version was the result of a lengthy, iterative process. These revisions are the result of a similar process conducted in 1996.

    Appreciation goes to the many APSAC members who contributed their time and expertise to produce these Guidelines.

    The Guidelines will be updated periodically. Any comments or suggestions about them should be directed to Lucy Berliner through APSAC, 332 South Michigan Avenue, Suite 1600, Chicago, Illinois, 60604.

    Appendix D: ABCs of Coping with Cross-Examination

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    About the Author

    John E. B. Myers, J.D., Professor of Law at the University of the Pacific's McGeorge School of Law in Sacramento, California, is nationally recognized as an expert on investigation and litigation of child abuse and neglect. He is the author of numerous books and articles discussing legal issues in child abuse and neglect. His writing has been cited by more than 140 courts, including the U.S. Supreme Court and numerous state supreme courts. In addition, he is a regular speaker at conferences on child abuse.


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