EFTA00088888.pdf

Exhibit B EFTA00088888 Ctc•ckl.e 4.pdzAco Review Manuscript TRAUMA. VIOLENCE & ABUSE 2019, Vol. 20(2) 260-283 Facilitators and Barriers to Child Sexual C The Author(s) 2017 Abuse (CSA) Disclosures: A Research Artock roust guidelines: sacepub comlioumalvptimoskin DOI, 10117711124838017697312 Update (2000-20 I 6) nals sagepuboornlhomakva OSAGE Ramona Alaggial , Delphine Collin-Vezina2, and Rusan Lateefl 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 disdosures 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: (I) 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 CA 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 dis. dosure 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 facil- itators of CSA disclosure. Implications for practice in facilitating CSA disclosures are discussed with recommendations for future research. Keywords sexual abuse, child abuse, cultural contexts Introduction the same time global trends from systematic reviews and meta- analyses have found concerning rates of CSA, with averages of Timely access to supportive and therapeutic resources for child 18-20% for females and of 8-10% for males (Pereda, Guilera, sexual abuse (CSA) survivors can mitigate risk to the health Fours, & Gomez-Benito, 2009). The highest rates found for and mental health well-being of children, youth, and adults. girls is in Australia (21.5%) and for boys in Africa (19.3%), Identifying and understanding factors that promote or inhibit with the lowest rates for both girls (11.3%) and boys (4.1%) CSA disclosures have the potential to facilitate earlier disclo- reported in Asia (Stoltenborgh, van Uzendoorn, Euser, & sures, assist survivors to receive services without delay, and Bakermans-Kranenburg, 20 I 1). These findings point to the potentially prevent further sexual victimization. Increased incongruence between the low number of official reports of 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-VEzina, Sablonni, I Factor-Inwentash Faculty of Social Work. University of Toronto. Toronto. Palmer, & Milne, 2015; Crisma, Bascelli, Paci, & Romito, Ontario. Canada 2004; Easton, 2013; Goodman-Brown, Edelstein, Goodman, 2 Centre for Research on Children and Families. School of Social Work, McGill Jones, & Gordon, 2003; Hershkowitz, Lanes, & Lamb; 2007; University. Montreal. Qubec. Canada Jonzon & Lindblad, 2004; McElvaney, 2015; Smith et al., 2000). Corresponding Author: Ramona Alaggia. Factor-Inwentash Chair in Children's Mental Health. Factor- Incidence studies in the United States and Canada report Inwentash Faculty of Social Work. University of Toronto. 246 Moor St West. decreasing CSA rates (Fallon et al., 2015; Finkelhor, Shattuck, Toronto, Ontatio, Canada M4K I W I. Turner, & Hamby, 2014; Trocme et al., 2005, 2008), while at ramonaalaggiaeutorortoca EFTA00088889 Alaggia et al. 261 CSA to authorities and the high rates reported in prevalence disclosure research, through various mixed methods, to high- studies. For example, a meta-analysis conducted by Stolten- light the most convincing findings that should be considered for borgh, van LIzendoom, Euser, and Bakermans-Kranenburg future research, practice, and program planning. This review (2011) combining estimations of CSA in 217 studies published centered on the question: What is the state of CSA disclosure between 1980 and 2008 revealed rates of CSA to be more than research and what can be learned to apply to future research 30 times greater in studies relying on self-reports (127 in 1,000) and practice? By way of clarification, the term systematic than in official report inquiries, such as those based on data refers to a methodologically sound strategy for searching liter- from child protection services and the police (4 in 1,000) (Ju- ature on studies for knowledge construction, in this case the lian, Cotter, & Perreault, 2014; Statistics Canada 2013). In CSA disclosure literature, rather than intervention studies. The other words, while 1 out of 8 people retrospectively report years spanned for searching the literature were 2000-2016, having experienced CSA, official incidence estimates indicate building on previous reviews without a great deal of overlap. only 1 per 250 children. In a survey of Swiss child services, Retrieval of relevant research was done by searching interna- Maier, Mohler-Kuo, Landholt, Schnyder, and Jud (2013) fur- tional electronic databases: PsycINFO, PsycARTICLES, Edu- ther found 2.68 cases per 1,000 of CSA disclosures, while in a cational Resources Information Center, Canadian Research recent comprehensive review McElvaney (2015) details the Index, International Bibliography of the Social Sciences, Pub- high prevalence of delayed, partial, and nondisclosures in lished International Literature on Traumatic Stress, Sociologi- childhood indicating a persistent trend toward withholding cal Abstracts, Social Service Abstracts, and Applied Social CSA disclosure. Science Index and Abstracts. This review searched peer- It is our view that incidence statistics are likely an under- reviewed studies. A search of the gray literature (unpublished estimation of CSA disclosures, and this drives the rationale for literature such as internal agency documents, government the current review. Given the persistence of delayed disclosures reports, etc.) was beyond the scope of this review because with research showing a large number of survivors only dis- unpublished studies are not subjected to a peer-review process. closing in adulthood (Collin-Vezina et al., 2015; Easton, 2013; Keyword search terms used were child sexual abuse, childhood Hunter, 2011; McElvaney, 2015; Smith et al., 2000), these sexual abuse, disclosure, and telling. issues should be a concern for practitioners, policy makers, and A search of the 9 databases produced 322 peer-reviewed the general public (McElvaney, 2015). The longer disclosures articles. Selected search terms yielded 200 English publica- are delayed, the longer individuals potentially live with serious tions, I French study, and I Portuguese review. The search was negative effects and mental health problems such as depres- further refined by excluding studies focusing on forensic inves- sion, anxiety, trauma disorders, and addictions, without receiv- tigations, as these studies constitute a specialized legal focus on ing necessary treatment. This also increases the likelihood of interview approaches and techniques. As well, papers that more victims falling prey to undetected offenders. Learning focused exclusively on rates and responses to CSA disclosure more about CSA disclosure factors and processes to help were excluded, as these are substantial areas unto themselves, advance our knowledge base may help professionals to facil- exceeding the aims of the review question. Review articles itate earlier disclosures. were also excluded. Once the exclusion criteria were applied, Previous literature reviews examining factors influencing the search results yielded 33 articles. These studies were sub- CSA disclosure have served the field well but are no longer jected to a thematic analysis as described by Braun and Clarke current. Important contributions on CSA disclosures include (2006). This entailed (I) multiple readings by the three authors; Paine and Hansen's (2002) original review covering the liter- (2) identifying patterns across studies by coding and charting ature largely from the premillennium era, followed by London, specific features; (3) examining disclosure definitions used, Bruck, Ceci, and Shuman's (2005) subsequent review, which sample characteristics, and measures utilized; and (4) major may not have captured publications affected by "lag to print" findings were extrapolated. Reading of the articles was initially delays so common in peer-reviewed journals. These reviews conducted by the authors to identify general trends in a first are now dated and therefore do not take into account the level of analyses and then subsequently to identify themes plethora of research that has been accumulated over the past through a deeper second-level analyses. A table of studies was 15 years. Other recent reviews exist but with distinct contribu- generated and was continuously revised as the selection of tions on the dialogical relationalprocesses of disclosure (Reit- studies was refined (see Table 1). sema & Grietens, 2015), CSA disclosures in adulthood (Tener & Murphy, 2015), and delayed disclosures in childhood (McEl- vaney, 20I5). This literature review differs by focusing on CSA Key Findings disclosures in children, youth, and adults from childhood and First-level analysis of the studies identified key study charac- into adulthood—over the life course. teristics. Trends emerged around definitions of CSA disclosure, study designs, and sampling issues. First, in regard to defini- tions, the term "telling" is most frequently used in place of the Method term disclosure. In the absence of standardized questionnaires Kiteley and Stogdon's (2014) systematic review framework or disclosure instruments, telling emerges as a practical term was utilized to establish what has been investigated in CSA more readily understood by study participants. Several EFTA00088890  Table I. Ch d Sexua Abuse (CSA) D se osure Stud es: 2000-2016. Study Purpose Des gn Samp e F nd ngs Summary Gagner and Co n- To exp ore d sc osure Phenomeno og ca 17 men ranged n age The major ty of the men n the study wa ted A part c pants had d sc osed and Vez na (2016) processes for ma e methodo ogy used to from 19 to 67— unt adu thood to d sc ose the r abuse. rece ved sery ces before v a ms of CSA ntery ew ma e CSA average age 47. w th negat ve stereotypes contr but ng part c pat ng n the study. Member sun vors. The Long Purpos ve samp ng to the r de ayed d sc osures. Negat ve check ng cou d not be done w th Intery ew Method strategy was used stereotypes contr buted to de eyed the part c pants to check themes. (LIM) gu ded data d sc osure w th try ng to forget. Break ng Sma but suff c ent s ze for a co ea on and so at on was c ted as a mot vator to qua tat ve nqu ry. Otherw se, ana yses. d sc osure a ong w th the a d of var ous h gh eve of r gor n estab sh ng forms of med a on d sc osure. Important trustworth ness of the data and contextua ssues such as negat ve ana ys s. Retrospect ve study stereotyp ng of ma es. sexua ty. and cou d mp y reca ssues v ct ms were noted. Soc a med a was seen as a fac ater of d sc osures Braze ton (2015) To exp ore the mean ng Co ect ve case study 17 Afr can Amer can CSA onset was arge y between the ages 5 One of few stud es to focus Afr can Amer can des gn w th us ng women n m d- fe and 9. No one ever ta ked to them about exc us ve y on Afr can Amer can women make of the r narrat ve wad t on between 40 and 63 sex, so they d dn't have anguage to women. Sma but suff cent s ze traumat c exper ences (storyboard) for data who exper enced d sc ose. Barr en: fear of fam y for a qua tat ve nqu ry. Important w th CSA and how co ect on and ana ys s. ntrafam a CSA. breakdown and remova , not want ng to cu tura and contextua ssues they d sc osed across Qua tat ve Purpos ve. snowba ng tarn sh the fam y's name, and fear of were brought forward. the fe course ntery ew ng strategy retr but on by tam y members f they Retrospect ve study that may d sc osed. Pattern of st fed and have been affected by reca ssues. d sm ssed d sc osures dent f ed over the Use of a fe-course perspect ye as fe course. A 17 part c pants dent f ed a theoret ca ens for sp r tua ty as a pr mary source of understand ng CSA n the m dd e strength throughout the fe course to ater years of fe that shou d be cons dered n further nvest gat ons Co n-Vez na, Sab onn . To prov de a mapp ng of Qua tat ve des gn us ng 67 ma e and fema e CSA Three broad cantor es were dent fed as Ha f of the part c pants had not Pa mer, and M ne factors that prevent LIM. adu t sun von (76% barr en to CSA d sc osure: Barr ers d sc osed the r CSA exper ences (20 I 5) CSA d sc osures dent f ed as fema e and from w th n- nterna zed v a m b am ng, before the age of 19. through an eco og ca 24% as ma e). Age mechan sms to protect onese f. and Retrospect ve aspect of the study ens from a samp e of ranges from 19 to 69 mmature deve opment at t me of abuse: cou d mp y reca ssues. A CSA adu t sun vors. years (M = 44.9). barr en n re at on to others—v o ence pan c pants had d sc osed and Purpos ye samp ng and dysfuna on n the fam y, power rece ved counse ng at some strategy dynam cs. awareness of the mpact of before part c pat ng n the study. to ng, and frag e soc a network; H gh eve of rgor n estab sh ng barr en n re at on to the soc a wor d trustworth ness of the data and abe ng, taboo of sexua ty, ack of ana ys s sery ces ava ab e. and cu ture or t me per od. Lec erc and Wort ey Study object ves Adu t ma e ch d sexua 369 adu t ma es who had D sc osure ncreased w th the age of the Offender generated data through (20 I 5) nvest gated the offenders were been cony cted of a v ct m: f penetrat on had occurred, f the se (-reports cou d be subject to factors that fac tate ntery ewed to sexua offense aga nst a v ct m was re aced to the offender, f the cogn t ve d stort ons— CSA d sc osures exam ne pred ctors of ch d aged between v ct m was not v ng w th the offender at m n m zat on or exaggerat ons. (continued) EFTA00088891  Table I. (cont nued) Study Purpose Des gn Samp e F nd ngs Summary v ct m d sc osure. and I7 years o d. the t me of the abuse. or f the v a m Perspect ves of offenders on Sem structured Major ty were Wh te. res sted dur ng the offense. Mae v ct ms vu nerab ty of v ct ms n re at on ntery ews based on uneducated, a most and v a ms from dysfuna ona to d sc osure cou d be mportant the QID ha f unemp oyed backgrounds were ess ke y to d sc ose nformat on to nform quest onna re. before the r arrest ntervent ons McE vaney and Cu hanc To nvest gate the F e reports of ch dren Content ana ys s was Major ty of ch dren to d the r mothers The samp e s ze s sma but w (2015) teas b ty of us ng ch d seen for assessment n comp eted on 39 f es (43%) and peers (33%) f rst_ Three major contr bute to a arge mu t s te assessments as data a ch d sexua abuse (32 fema es and 7 themes were dent fed as of uenc ng the study n Ire and. Serves as an sources of nforma un t n a ch dren's ma es) based on a d sc osure process: (I) fee ng d stressed. mportant exp oratory p of CSA d sc osure. To hosp ta were cod ng framework. (2) opportun ty to te . and (3) fears for br ng ng forward d sc osure assess f these reports rev ewed Parents were asked to se f. Add t ona themes of be ng be eyed. themes for cons dent on prov de substant ve consent to have the r shame/se f-b ame. and peer of uence data on d sc osures ch d's f e rev ewed for were a so dent fed the study. V ct ms assessed were 12-18 years of age Dumont, Messerschm tt Th s study a med to F e reports of ch dren 220 m nor v a ms- D sc osure processes were more comp ex The re at onsh p w th the V a, Bohu. and exp ore how the seen for assessment n 78.2% fema e v a ms. when t concerned sexua abuse perpetrator has a s gn f cant Rey-Sa mon (2014) re at onsh p between a ch d sexua abuse 41.8% aged between comm tted by ntrafam a perpetrator: mpact on both t m ng and the perpetrator and un t n a ch dren's 14 and 18 (most 60% of the v a ms revea the facts rec p ent of d sc osure. w th the v ct m, espec a y hosp ta were preva ent age range). seven years after, and most often to ntrafam a abuses ess ke y to whether these rev ewed and 48.2% were nd v dua s outs de the fam y (78.6% of be d sc osed prompt y and w th n re at ons are abused by a fam y the d sc osures done at schoo ): on the the fam y system ntrafam a or member contrary. extrafam a d sc osures take extrafam a, mpact p ace more spontaneous y and qu ck y: CSA d sc osure 80% of the v a ms revea the facts a few days after, most often to the r mother or peers Easton. Sa tzman. and Study focus was on Us ng qua tat ye content 460 men w th CSA Vast major ty of part c pants (94.6%) were At t me of the study. th s was the W 5 (20 I 4) dent f cat on of ana ys s, researchers h stor es comp eted an sexua y abused by another ma e. argest qua tat ve data set to have barr en to CSA conducted a secondary anonymous, Internet- Durst on of sexua abuse broke down been ana yzed w th an exp c t d sc osure w th ma e ana ys s of on ne based survey. nto: 30.2% ess than 6 months. 32.3% 6 focus on adu t ma e sury vors' sury von survey data. the 2010 Recru ted from months to 3 years. and 34.3% more than percept ons of barr en to CSA Heath and We -Be ng sury vors' 3 years. Ten years o d was average age of d sc osure. Because the samp e Survey, that nc uded organ zat ons. Age CSA onset Ten categor es of barr en was m ted n terms of the ow men w th se (-reported range of 18-84 years. were c ass fed nto three doma ns: (I) percentage of rac a m nor t es CSA h stor es w th an Two th rds of soc opo t ca: mascu n ty. m ted (9.3%). d sc osure d fferences open-ended tem on respondents reported resources; (2) nterpersona : m strust of based on race or ethn c ty were d sc osure barr ers c ergy-re ated abuse. others, fear of be ng abe ed "gay," safety not d scerned. The major ty of Major ty of and protect on ssues, past responses: abuse reported was by c ergy respondents were and (3) persona: ntema emot ons. wh ch m ght present a un que set Wh te see ng the exper ence as sexua abuse. of barr ers to d sc osure and sexua or enat on. (continued) EFTA00088892  Pi Table I. (corm nued) Study Purpose Des r Samp e F nd ngs Summary Easton (2013) Study purpose was to Cross-sect ona survey Purpos ve samp ng of O der age and be ng abused by a fam y Purpos ve samp ng of men from descr be ma e CSA des grt.E g be 487 men from three member were both re ated to de ays n awareness n s ng organ zat ons d sc osure processes part c pants were nat ona organ zat ons d sc osure. Most part c pants who to d may have attracted part cu ar us ng a fe span screened and devoted to ra s ng someone dur ng ch dhood d d not part c pants who had a ready approach exam n ng comp eted an awareness of CSA rece ve emot ona y support ve or d sc osed and rece ved he p. d fferences based on anonymous, Internet- among men. Age protect ve responses and the he pfu ness Part c pants needed to have age. A so. to exp ore based survey dur ng range: 19-84 years. of responses across the fe span was access to Internet wh ch wou d re at onsh ps between 2010. Measures used: Mean age for onset of m xed. De ays n te ng were s gn f cant have e m nated men n ower SE d sc osure attr butes Genera Menta Heath CSA was 10.3 years per ods oft me (over 20 years). groups and requ red prof c ency n and men's menta D stress Sca e and Approx mate y one ha f of the Eng sh wh ch wou d e m nate hea th Genera Assessment of part c pants f rst to d about the sexua certa n cu tun groups. However. Ind v dua Needs. abuse to a spouse/partner (27%) or a the samp ng strategy ga ned Quest ons re ated to menta heath profess ona (20%): 42% of access to a predom nant y h dden CSA d sc osure and part c pants reported that the r most popu at on. Important c n ca supports were he pfu d scuss on was w th a menta recommendat ons are made w th nc uded heath profess ona. However. unhe phi an emphas son a fe-course focus responses caused most menta d stress. C n a recommendat ons nc uded more of a fe-course perspect ve be adopted. understand ng mpact of unhe pfu responses and the mportance of expand ng networks for ma e sury von McE vaney. Greene. and Qua tat ve study asked Grounded theory Samp e of 22 young A theoret ca mode was deve oped that Modest but suff c ent samp e for an Hogan (2012) the cents research method study. peop 16 g r s and 6 conceptua zes the process of CSA exp oratory qua tat ve nqu ry. quest on: "How do Intery ews were boys: age range: 8-18 d sc osure as one of conta n ng the H gh eve of trustworth ness ch dren te ?" conducted. L ne-by- years: 22 ntery ewed secret (I) the act ve w thho d ng of the r gor. A subsamp e of random y Object ve was to ne open and ax a n ton between the secret on the part of the ch d; (2) the se ected transcr pts was deve op theory of how cod ng was conducted ages of 8 and 18. M xed exper ence of a "pressure cooker effect" ndependent y coded. Very young ch dren te of the r on verbat m samp e of some ref ect ng a conf a between the w sh to ch dren and young adu is were CSA d sc osure transcr pts endurng ntrafam a te and the w sh to keep the secret; and not captured n th s samp e. exper ences. Parents CSA, some (3) the conf d ng Ise f wh ch often Transferab ty of f nd ngs can on y were ntery ewed. extrafam a CSA, and occurs n the context of a trusted be made to the age range samp ed two endured both re at onsh p. These were der ved from n the context of Ire and forms e even categor es that were deve oped through open and ax a cod ng Sthonbucher, Ma er, To nvest gate the Data co ect on was Conven ence samp e of Less than one th rd of part c pants Two th rds of the samp e d d not Moh er-Kuo, Schnyder, process of CSA through face-to-face 26 sexua y v ct m zed mmed ate y d sc osed CSA to another d sc ose r ght away. Strengthen ng and Lando t (20 I 2) d sc osure w th qua tat ve ntery ews. ado escents. 23 g r s person. In most cases, rec p ents of both parent—ch d re at onsh ps may be ado escents from the Standard zed quest ons and 3 boys. Age range: mmed ate and de ayed d sc osure were one of the most mportant ways genera popu at on and measures were I5—I8 years. On ne to peers. More than one th rd of to ncrease d sc osure to parents. who had exper enced adm n stered on fam y advert cements and part c pants had never d sc osed the D sc osure to peers has been CSA. How many s tuat on. f yen were used to abuse to a parent. Part c pants reported found a common trend n other d sc cued, who d d soc odemograph c recru t youth from re uctance to d sc ose to parents so as (continued) EFTA00088893  Table I. (cant nued) Study Purpose Des gn Samp e F rid ngs Summary they d sc ose to, and data, sexua commun ty and not to burden them. Ear er d sc osures research and bears more what were the r v ct m sat on. genera . counse ng sem ces were re ated to extrafam a CSA, s ng e exam nat on mot ves for d sc os ng and menta hea th. occurrence CSA, age of v ct m at abuse Sexua Assau t Modu e onset. and parents who were v rig of the Juven e together. H gher eves of reported gu t V ct m sat on and shame were re ated to de ayed Quest onna re was d sc osures. Peers were v ewed by th s used samp e as more re ab e conf dants Hunter (20 I I ) A m of the study was to Narrat ve nqu ry Purpos ve samp ng was On y 5 out of 22 part c pants to d anyone De ayed d sc osure was common n deve op a fu er methodo ogy. Face-to- emp oyed. Samp e about the r ear y sexua exper ences as th s qua tat ve samp e. Most understand rig of CSA face n-depth cons sted of 22 ch dren. Fear, shame, and se f-b ame part c pants d d not make a d sc osures ntery ews were part c pants aged 25- were the man rah b ton to d sc osure. se ect ve d sc osure unt conducted w th 70 years: 13 women These factors are further den ed adu thood. These f nd ngs support part c pants. Data and 9 men. Part c pants through subthemes. Te ng as a ch d and A agg a's (2004) mode of were ana yzed us ng were sexua y abused as an adu t was further expanded upon d sc osure but a so h gh ghts the Rosentha and F scher— at IS years or under us ng A agg a's (2004) framework mportance of fe stage. Modest Rosentha 's (2004) w th someone over ver fy ng behav on rid rect attempts to but surf c ent samp e s ze for a method. the age of It te and purposefu d sc osure as qua tat ve nqu ry. We -des gned categor es. Thematcana ys s supported study w th den ed aria ys s for that CSA d sc osure shou d be transferab ty off nd ngs conceptua zed and v ewed as a comp ex and fe ong process Schaeffer. Leventha , and Th s study a med to: (I) Study sought to fnd out f 191 ntery ews of CSA Reasons the ch dren dent fed for te rig An nnovat ve study to try to assess Asnes (2011) add d rect nqu ry process ssues of v ct ms aged 3-18 over were c ass f ed nto three doma ns: (1) f forma nvest gat ve ntery ews about the process of a d sc osure cou d be a -year per od were d sc osure as a resu t of nterna sc mu can fac tate d sc osures of CSA. ch d's CSA d sc osure; dent( ed n the used for the study. (e.g. the ch d had n ghtmares): (2) Data were based on a arge (2) determ ne f context of forens c Inc us on cr ter a d sc osure hc ated by outs de number of ntery ews. Den ed ch dren w d scuss ntery ews. Forens c nc uded ch dren who of uences (e.g. the ch d was ana ys s produced den ed process that ed them ntery ewers were made a statement quest oned): and (3) d sc osure due to f rid ngs support ng other study to te : and (3) descr be asked to ncorporate about CSA pr or to d rect ev dente of abuse (e.g., the ch d's f rid ngs on CSA d sc osure factors that ch dren quest ons about refers. reasons for abuse was w tnessed). The barr ers to dent fy that ed them "te rig" nto an te ng or wa t ng to d sc osure dent f ed fe nto f ve groups: to te about or caused ex st rag forens c te , and those who (I) threats made by the perpetrator them to de ay CSA may ew protoco . spoke Eng sh. (e.g.. the ch d was to d she or he wou d d sc osure Intery ew content Part c pants were get n troub e f she or he to 4 (2) fears re ated to the ch dren who were (e.g.. the ch d was afra d someth ng bad ch dren's reasons for ntery ewed at a ch d wou d happen f she or he to d), (3) ack te ng or wa t ng was sexua abuse c n c. of opportun ty (e.g., the ch d fe t the extracted, cranscr bed, 74% were ferna e and opportun ty to d sc ose never and ana yzed us rig 51% were Caucas an presented), (4) ack of understand ng grounded theory (e.g.. the ch d fa ed to recogn ze abus ve method of ana ys s behav or as unacceptab e), and (5) re at onsh p w th the perpetrator (e.g. the ch d thought the perpetrator was a fr end) (continued) EFTA00088894  I-, Table I. (tom nued) P Study Purpose Des gn Samp e F nd ngs Summary A agg a (2010) The study a med to A qua tat ve Purpos ye samp ng was Themes fe nto four doma ns: (I) The study presents a comprehens ve dent fy factors phenomeno og ca emp oyed. Snowba nd v dua and deve opmenta factors, soc a —eco og ca ana ys s to CSA mped ng or promot ng des gn. LIM, was used samp ng was a so used deve opmenta factors as to whether d sc osure h gh ght ng the CSA d sc osures. to ntery ew adu t CSA to recru t more ma e they comprehended what was mu t faceted nf uences. Of note, Overarch ng research sury vors about the r sun von. 40 adu t happen ng, persona ty tra ts a so had 42% had d sc osed the abuse quest on: What d sc osure exper ences sun von of CSA were some bear ng on the r ab ty to te . and dur ng ch dhood: 26% had not nd v dua, to prov de ntery ewed: 36% men ant c pat ng not be ng be eyed; (2) d sc osed because they had nterpersona . retrospect ve accounts and 64% women. Age d sc osure nh b ted by fam y repressed the memory, or the env ronmenta . and of CSA d sc osure and range of 18-65 w th a character st cs such as rgdy fxed abuse had occurred n preschoo contextua nf ue