The victims and juvenile perpetrators of child sexual abuse – assessment and intervention

Background: The assessment of victims of child sexual abuse (CSA) is now a recognized aspect of clinical work for both CAMH and adult services. As juvenile perpetrators of CSA are responsible for a significant minority of the sexual assaults on other children, CAMH services are increasingly approached to assess these oversexualized younger children or sexually abusive adolescents. A developmental approach to assessment and treatment intervention is essential in all these cases. Method: This review examines research on the characteristics of child victims and perpetrators of CSA. It describes evidence-based approaches to assessment and treatment of both groups of children. A selective review of MEDLINE, Psycinfo, Cochrane Library, and other databases was undertaken. Recommendations are made for clinical practice and future research. Findings: The characteristics of CSA victims are well known and those of juvenile perpetrators of sexual abuse are becoming recognised. Assessment approaches for both groups of children should be delivered within a safeguarding context where risk to victims is minimized. Risk assessment instruments should be used only as adjuncts to a full clinical assessment. Given high levels of psychiatric comorbidity, assessment, treatment, and other interventions should be undertaken by mental health trained staff. Conclusions: Victims and perpetrators of CSA present challenges and opportunities for professional intervention. Their complex presentations mean that their needs should be met by highly trained staff. However, their youth and developmental immaturity also give an opportunity to nip problem symptoms and behaviors in the bud. The key is in the earliest possible intervention with both groups. Future research should focus on long term adult outcomes for both child victims and children who perpetrate CSA. Adult outcomes of treated children could identify problems and/or strengths in parenting the next generation and also the persistence and/or desistence of sexualized or abusive behavio

B641: A Comparison of Food Prices in Boston, Massachusetts and Bangor, Maine: December, 1965

The results of this study, using store surveys and advertised price comparisons, showed that the cost of food-at-home items is higher in Bangor than in Boston. In addition to higher average prices in Bangor for many items, the total average expenditure for the group of food items is 4% higher in Bangor. Although it is clear that the cost of food is higher in Bangor, the study made no attempt to determine any of the causes of the cost differentia1. Two possible reasons might be the distance of Bangor from some of the major food suppliers and the difference in existing competition between Bangor and Boston.https://digitalcommons.library.umaine.edu/aes_bulletin/1062/thumbnail.jp

Positive practices : solution-focused and narrative therapeutic techniques with children with sexually harmful behaviours

This article explores the use of solution-focused and Narrative Therapeutic approaches with a boy who had sexually harmful behaviours. The paper will highlight the practical challenges of working with someone who is 'problem-saturated' through institutionalisation and who is also subjected to powerful discourses claiming the 'truth' about him. The use of solution-focused and Narrative Therapeutic principles and approaches will be demonstrated in the work described, in a way that allows the reader to reflect on how these may differ from modernist understandings and responses to this behaviour

Practitioner Review: effectiveness of indicated school-based interventions for adolescent depression and anxiety - a meta-analytic review

Background: Interest in delivering psychological interventions within schools to facilitate early intervention is increasing. However, most reviews have focused on universal or preventative programmes rather than interventions designed to decrease existing symptoms of depression or anxiety. This paper aims to provide a meta-analytic review of randomised controlled trials of indicated psychological interventions for young people aged 10-19 with elevated symptoms of depression and/or anxiety. Methods: Eight electronic databases were systematically searched from inception to April 2019 for eligible trials. Study quality was assessed using two scales designed to evaluate psychotherapy intervention trials. Random effects meta-analyses were conducted separately for trials that recruited participants based on symptoms of depression and based on symptoms of anxiety. Results: Data from 45 trials were analysed. Most interventions studied used cognitive and behavioural strategies. Few studies met methodological quality criteria, but effect size was not associated with study quality. Indicated school-based interventions had a small effect on reducing depression symptoms (SMD = 0.34, 95% CI -0.48, -0.21) and a medium effect on reducing anxiety symptoms (SMD=-0.49, 95% CI -0.79, -0.19) immediately post-intervention. Subgroup analyses indicated that interventions delivered by internal school staff did not have significant effects on symptoms. Reductions in depression were maintained at short-term (≤6 months) but not medium (>6 months ≤12) or long-term (>12 month) follow up. Reductions in anxiety symptoms were not maintained at any follow up. Conclusions: Indicated school-based interventions are effective at reducing symptoms of depression and anxiety in adolescents immediately post-intervention but there is little evidence that these reductions are maintained. Interventions delivered by school staff are not supported by the current evidence-base. Further high quality randomised controlled trials incorporating assessment of longer-term outcomes are needed to justify increased investment in school-based interventions for adolescent depression and anxiety

Resources for sports engineering education

This paper serves as a resource guide for Sports Engineering educators. The paper covers key topics in Sports Engineering, including ball impact, friction, safety and materials. A variety of resource types are presented to reflect modern methods of learning and searching for information, including textbooks, research and review papers, websites and videos. The field could benefit from more resources specifically designated for teaching Sports Engineering, particularly textbooks

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

Background: Many patients with COVID-19 have been treated with plasma containing anti-SARS-CoV-2 antibodies. We aimed to evaluate the safety and efficacy of convalescent plasma therapy in patients admitted to hospital with COVID-19. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]) is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. The trial is underway at 177 NHS hospitals from across the UK. Eligible and consenting patients were randomly assigned (1:1) to receive either usual care alone (usual care group) or usual care plus high-titre convalescent plasma (convalescent plasma group). The primary outcome was 28-day mortality, analysed on an intention-to-treat basis. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936. Findings: Between May 28, 2020, and Jan 15, 2021, 11558 (71%) of 16287 patients enrolled in RECOVERY were eligible to receive convalescent plasma and were assigned to either the convalescent plasma group or the usual care group. There was no significant difference in 28-day mortality between the two groups: 1399 (24%) of 5795 patients in the convalescent plasma group and 1408 (24%) of 5763 patients in the usual care group died within 28 days (rate ratio 1·00, 95% CI 0·93–1·07; p=0·95). The 28-day mortality rate ratio was similar in all prespecified subgroups of patients, including in those patients without detectable SARS-CoV-2 antibodies at randomisation. Allocation to convalescent plasma had no significant effect on the proportion of patients discharged from hospital within 28 days (3832 [66%] patients in the convalescent plasma group vs 3822 [66%] patients in the usual care group; rate ratio 0·99, 95% CI 0·94–1·03; p=0·57). Among those not on invasive mechanical ventilation at randomisation, there was no significant difference in the proportion of patients meeting the composite endpoint of progression to invasive mechanical ventilation or death (1568 [29%] of 5493 patients in the convalescent plasma group vs 1568 [29%] of 5448 patients in the usual care group; rate ratio 0·99, 95% CI 0·93–1·05; p=0·79). Interpretation: In patients hospitalised with COVID-19, high-titre convalescent plasma did not improve survival or other prespecified clinical outcomes. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

The Nature and the Status of the Evidence on the Prevention of Child Sexual Abuse by Men and Boys

This Podcast by Eileen Vizard covers the main issues she presented at the ISPCAN Denver Thinking Space Conference on 13th March 2013. She discusses the implications of the findings for wider society in terms of policy and practice. The original ISPCAN powerpoint presentation covers definitions of the problem, prevalence, types of abuse and abusers, treatment approaches and outcomes, the status of the evidence and whether or not prevention is possible

Sexually harmful behaviour in children and young people with learning difficulties

Children and young people with learning disabilities (LD) often show a wide range of emotional and behavioural problems which tend to increase in inverse proportion to the degree of cognitive impairment. Co-morbidity for mental health problems in LD is well known and care planning and management can follow agreed protocols. However, the co-occurrence of serious behavioural problems including sexually harmful behaviour (SHB) adds considerable complexity to these processes. Ethical issues can arise in relation to the fitness to plead of seriously impaired young people facing criminal charges and also in relation to the ‘wishes and feelings’ of oversexualised young people with LD who target younger/more vulnerable children. Early referral of children and young people with LD and SHB should not be deferred for spurious reasons including concerns about ’labelling’ or ‘stigmatisation’. Clinical experience and research suggests that delay in referral is harmful to the subsequent development of children and young people with LD and may put other children and members of the public at risk of sexual assault if appropriate help is not given