Sexual Abuse and Assault

Dr. Ted Cross of CFRC has been conducting research on the response to sexual victimization for over 25 years, and this website profiles his research in this area since he joined CFRC in 2007.

Sexual victimization is particularly tragic and heinous because of its substantial negative effects on both child and adult victims. Yet developing effective, just responses to child sexual abuse and adult sexual assault is challenging, since much sexual victimization goes unreported. It is often difficult to obtain evidence beyond the victim's word against the perpetrator's, and often victims' credibility is questioned. More research is needed to inform the investigation and prosecution of sexual victimization as well as service delivery to survivors. Dr. Ted Cross of CFRC has been conducting research on the response to sexual victimization for over 25 years, and this website profiles his research in this area since he joined CFRC in 2007.

Dr. Cross has co-authored a number of publications evaluating children's advocacy centers, which are state-of-the-art multidisciplinary programs to respond to allegations of child sexual abuse and other serious abuse. Other publications he has co-authored examine investigation and prosecution of child abuse.

Dr. Cross and his colleagues have also been funded by the National Institute of Justice to study the role of medical evidence and crime laboratory evidence in the criminal justice response to child sexual abuse and adult sexual assault.



Apr 2016 / Presentation / Sexual Abuse and Assault

Forensic Evidence and Criminal Justice Outcomes in a Statewide Sample of Sexual Assault Cases

Ted Cross

This presentation provided useful findings on forensic evidence and on sexual assault to both unit leaders and first responders in the United States Air Force, drawing from Dr. Ted Cross’ National Institute of Justices-funded research. Results from an initial study suggest that crime laboratory evidence plays a role in only a small number of arrests in sexual assault cases, because the vast majority of arrests take place soon after the reported incident, well before crime laboratory analysis. But DNA evidence was significantly more likely in the small number of arrests that took place later, after the crime laboratory analysis was completed. This suggests the potential impact of DNA in making arrests that occur well after the incident. In the second study, DNA matches were significantly related to obtaining convictions in sexual assault cases, though the DNA match could be both a cause and effect. A DNA match can identify an unknown suspect and strengthen the evidence against a known offender. But DNA matches can also be an effect of pursuing convictions, since prosecutors who were interviewed reported that, to be thorough, they always try to introduce DNA evidence in cases they carry forward, even if the case rests mostly on other evidence. Juries expect it. (Read more about Dr. Cross’ presentation in a news release here.)

Sep 2015 / Presentation / Sexual Abuse and Assault

When the Victim Is a Child: 30 Years of Progress for Child Victims in the Criminal Justice System

Debra Whitcomb and Theodore Cross

Prosecution of child abuse often depends on the ability of children to testify in court, but this places enormous demands on children and risks exacerbating the effects of the abuse. This presentation provides an overview of research and legal and practice development on child abuse victims in the courtroom in recent decades, and presents new survey data from prosecutors and Children's Advocacy Centers about current challenges of prosecuting child abuse and what steps professionals are taking to protect and support children in court. It was originally presented at annual conference of the Institute of Violence, Abuse and Trauma in San Diego, CA in September 2015.

Jul 2015 / Presentation / Sexual Abuse and Assault

DNA, Biological Evidence, Injuries and Arrests for Child and Adolescent Sexual Assault Victims with Acute Medical Examinations

Ted Cross

This presentation compares child, adolescent and adult cases receiving forensic medical examinations following sexual assault. Data come from a National Institute of Justice-funded study of 563 medical examinations conducted across Massachusetts from 2008 to 2010, which included data from medical, crime laboratory and police reports. Results suggest that adolescent victims present severe challenges that are different from those of younger victims, challenges similar to those faced by adults. Adolescents were at higher risk for injury than younger children, and for cases being dropped by police. Biological evidence was more prevalent too, which can enhance opportunities for pursuing justice but also places a premium on adolescents undergoing medical examination. The needs of the adolescents, who were as young as 12, are different from both younger children and adults, and systems and practice models have not been developed that are specifically tailored to this age group. These results could help inspire the development of enhanced models of care specifically aimed at adolescent victims of sexual assault.

Jun 2015 / Presentation / Sexual Abuse and Assault

Children’s Advocacy Centers and Research: A Review of What We Have Learned and a Look to the Future

Theodore Cross and Wendy Walsh

Children’s Advocacy Centers (CACs) are multidisciplinary centers designed to coordinate all professionals involved in the investigative and service response to child abuse. They provide forensic child interviews with interviewers trained in best practice and a multidisciplinary team to coordinate the work of child protection, law enforcement, prosecution, health, mental health and other professionals. Over 700 CACs are providing services across all 50 states and in several foreign countries. This presentation presents an overview of research involving CACs. Several studies suggest the efficacy of CACs for improving several aspects of the response to children, and a number of important studies expanding knowledge on child maltreatment have been conducted in CACs. Several opportunities and challenges of doing research in CACs are discussed, and new results from a survey of CAC directors on Center practice are presented. This presentation was originally given at the One Child, Many Hands Multidisciplinary Conference on Child Welfare in Philadelphia in June 2015.

Nov 2014 / Presentation / Sexual Abuse and Assault

Prosecutor Assessment of the Value of Physical and Forensic Evidence in Sexual Assault Cases

Theodore Cross, Megan Alderden, Alex Wagner, Lisa Sampson, Brittany Peters, Kaitlin Lounsbury, Laura Siller

The use of forensic evidence in sexual assault cases is prominent in TV crime dramas, but no studies have examined how prosecutors actually use forensic evidence in these cases and what impact it has in trials. This presentation provides preliminary qualitative results from a mixed methods study of the role of forensic evidence in sexual assault cases in an urban district attorney's office. Assistant district attorneys were interviewed about their experience in using forensic evidence on sexual assault and their observations about when and how it can be employed to effectively prosecute these crimes. They reported that forensic evidence can be effective in a variety of ways as part of a prosecution strategy with multiple forms of evidence.

Sep 2014 / Report / Sexual Abuse and Assault

Forensic Evidence and Criminal Justice Outcomes in a Statewide Sample of Sexual Assault Cases

Theodore P. Cross, Megan Alderden, Alexander Wagner, Lisa Sampson, Brittany Peters, Meredith Spencer, and Kaitlin Lounsbury

Biological evidence like DNA can be central to the investigation and prosecution of sexual assault, as can evaluation and documentation of injuries. But data are lacking on the actual impact of these forms of forensic evidence on the criminal justice system. Through a grant from the National Institute of Justice (NIJ), CFRC researcher Theodore Cross headed a team that examined the frequency and timing of forensic evidence and its relationship to arrest in a statewide sample of cases. Most arrests took place well before crime laboratory analysis could be conducted, but DNA profiles and matches to suspects were prominent in a small set of cases in which police had access to crime laboratory results prior to arrest. The final report to NIJ that we link to here highlights these results and many others on how often and when forensic evidence is available is a wide array of different types of sexual assault cases.

Jul 2014 / Presentation / Sexual Abuse and Assault

Forensic Evidence and Sexual Assault Update

Alexander Wagner, Theodore Cross, Megan Alderden, Lisa Sampson, Brittany Peters, and Meredith Spencer

Promising methods have emerged in the last tweny years for using DNA and other biological evidence in the investigation and prosecution of sexual assault, but there is little research on how often this type of evidence is available and what role it plays in the criminal justice response to sexual research. This presentation to the Massachusetts Association of Crime Analysts is one of a series reporting findings from of a National Institute Justice-funded study on the frequeny, use and impact of forensic evidence in criminal investigations of sexual assault. Results suggests that biological evidence and DNA does not play a role in the vast majority of arrests, which are typically made soon after the incident. But DNA is very prominent in a small number of cases in which arrests are made later, after crime laboratory analysis has been conducted.

Jul 2014 / Journal Publication / Sexual Abuse and Assault

The Timing of Forensic Evidence in Sexual Assault Cases

Megan Alderden and Theodore P. Cross

This newsletter article presents a brief overview of key findings from a study of forensic evidence in sexual assault cases and its relationship to arrest, focusing particularly on the role of timing. Most arrests took place well before crime laboratory analysis could be conducted, but DNA profiles and matches to suspects were prominent in a small set of cases in which police had access to crime laboratory results prior to arrest. Readers who want to glean important knowledge from this National Institute of Justice study with a brief investment of time can seek this article from the Sexual Assault Report newsletter.

Alderden, M & Cross, T.P. (2014). The timing of forensic evidence in sexual assault cases. Sexual Assault Report, 17, 83-84.
Nov 2013 / Presentation / Sexual Abuse and Assault

The Impact of Forensic Evidence on Sexual Assault Cases

Theodore P. Cross, Megan Alderden, Alex Wagner, A., Daniel Bibel, Lisa Sampson, Brittany Peters, Saijun Zhang, and Meridith Spencer

This presentation reports on a study of the relationship between injury evidence and crime laboratory evidence and police unfounding and arrest in a statewide sample of Massachusetts sexual assault csaes. Most arrests took place rapidly--before crime laboratory analysis was conducted, but in the small number of cases in which arrests took place afterwards DNA evidence was common--suggesting the importance of DNA when probable cause cannot immediately be established. Arrests were more likely when there were injuries, though the causal relationship is unclear. Additional predictors of unfounding and arrest were identified.

Oct 2013 / Journal Publication / Sexual Abuse and Assault

The Seven Pillars of Quality Care in a Statewide Pediatric Sexual Assault Nurse Examiner Program

Ted Cross, Joan Meunier-Sham, and L. Zuniga

This article describes a systematic approach used by a statewide pediatric sexual assault nurse examiner program to ensure the quality of forensic medical examinations it provides in child sexual abuse investigations. Seven strategies for enhancing quality are described: (a) hiring experienced professionals, (b) effective training, (c) comprehensive protocols, (d) ample support for pediatric sexual assault nurses, (e) management oversight, (f) a clinical coordinator to provide ongoing training and technical assistance, and (g) a quality assurance process in which expert child abuse pediatricians review each statewide pediatric sexual assault nurse examination. To show the evolution of quality care over time, the program's experience from 2004 to 2010 is reviewed, and quality assurance data are analyzed.

Sham, J.M., Cross, T.P. & Zuniga, L. (2013). The seven pillars of quality care in a statewide pediatric sexual assault nurse examiner program. Journal of Child Sexual Abuse, 22,722-739.

Dec 2012 / Research Brief / Sexual Abuse and Assault

Forensic Evidence in Child Sexual Abuse Cases: The Experience of Using a Statewide Pediatric Forensic Evidence Collection Kit

Theodore P. Cross, Joan Meunier-Sham and Cynthia L. Moore

This brief presents data on statewide implementation of the Massachusetts Pediatric Sexual Assault Evidence Collection Kit, a specially designed non-invasive kit for victims of child sexual abuse receiving acute forensic medical examinations. The kit yielded biological evidence in 33% of 283 cases, a rate that was comparable or higher than previous studies using traditional, more invasive methods.

Nov 2012 / Presentation / Sexual Abuse and Assault

Forensic Evidence in Sexual Assault Cases

Megan Alderden, Theodore P. Cross, Alexander Wagner, Daniel Bibel, Marjorie Bernadeau, Lisa Sampson, Saijun Zhang, Kaitlin Lounsbury and Brittany Peters

This presentation reports preliminary results from a study of forensic evidence in 587 adult sexual assault cases (victim age 12 and older) seen by medical providers in Massachusetts from 2008 to 2010.Non-genital injuries were found in 53% of victims, genital injuries in 41.1% of victims, and biological evidence in 86.9% of cases (the last included semen, blood, a saliva enzyme and/or other biological evidence). Over two thirds of medical examinations were conducted by nurses from the statewide Sexual Assault Nurse Examiners (SANE) program, who are specially trained to conduct forensic medical examinations in sexual assault cases, and less than one-third by other medical providers, primarily emergency department physicians. Black and Hispanic victims were significantly less likely to have non-genital injuries identified, which may relate to the contrast in color between the injury and skin. SANE nurses were significantly more likely to identify genital injuries; there was no significant difference on non-genital injuries. In 40.9% of cases in which some biological evidence was found, the crime labs were able to extract a DNA profile. In 37.9% of the cases with DNA profiles generated, the DNA matched the suspect in the case, in 8.3% the DNA matched the DNA in another investigation in a national DNA database, and in 17.5% the DNA matched a convicted offender in that database. There were no significant differences between SANE nurses and other medical providers on likelihood of forensic evidence, even though the SANEs, whose philosophy stresses empowering patient choices, were significantly less likely to use certain procedures such as pubic hair combings.

Sep 2012 / Presentation / Child Welfare Practice, Sexual Abuse and Assault, Well Being

Forensic Evidence Recovery in Pre-pubertal Children: The MA PEDI Kit Experience

Joan Meunier-Sham, Theodore Cross, and Cynthia Moore

This presentation reports research on Massachusetts Pediatric Forensic Evidence Collection Kit, the first evidence kit in the country specially created to collect forensic medical evidence in acute child sexual assault cases. The kit is designed to follow a set of "first do no harm" principles that make use of the kit less invasive and more supportive of children than traditional methods of medical examination. Statistical results are presented that show that the kits yield biological evidence following crime lab analysis at rates that are comparable to previous studies even while following the "do no harm" principles.

Jul 2012 / Research Brief / Child Welfare Administration and Policy, Sexual Abuse and Assault

Concurrent Criminal and Child Protective Services Investigations

Theodore Cross, Jesse Helton, and Emmeline Chuang

Some advocates argue that police too rarely conduct criminal investigations in Child Protective Services sexual abuse cases, while policy regarding police involvement in CPS physical abuse and neglect cases is not well developed. However, little research has examined how often police investigate in CPS cases and what factors predict involvement. Using two cohorts of cases (1999-2001 and 2008-2009) from the National Survey of Child and Adolescent Well-Being, a national probability study of children involved in CPS investigations, this presentation examines the frequency of criminal investigations in CPS cases and the factors predicting criminal investigation. Across cohorts, criminal investigations took place in 21% to 24% of all cases, 47% to 49% of sexual abuse cases, 24% to 27% of physical abuse cases and 15% to 18% of neglect cases. Police investigated more often when caseworkers reported greater risk and harm to the child and greater evidence, but variables like child age and relationship to perpetrator were not significant. Which county was involved, however, was a major predictor, with enormous variation in rates of police investigation across counties. Thus the likelihood of a criminal investigation depends on severity but also agency differences in practice. Equity suggests the need to discuss these differences.

Jul 2012 / Presentation / Child Welfare Administration and Policy, Sexual Abuse and Assault

The Criminal Justice Response to Child Abuse: Lessons Learned and Future Directions for Research and Practice

Theodore Cross

This day-long workshop presents a more comprehensive overview of 25 years of research on the criminal justice response to child maltreatment. Topics include the progress of child abuse cases through the criminal justice system, the effect of multidisciplinary teams, the impact of the court experience and testifying on child victims, factors associated with prosecution, and research on evidence and offender confession.

Jun 2012 / Presentation / Child Welfare Administration and Policy, Sexual Abuse and Assault

How Can We Be Effective in Pursuing Justice in Child Abuse Cases?

Theodore Cross

This 90 minute workshop presents a brief overview of 25 years of research on the criminal justice response to child abuse. Topics include the progress of child abuse cases through the criminal justice system, the effect of multidisciplinary teams, the impact of the court experience and testifying on child victims, factors associated with prosecution, and research on evidence and offender confession.

Feb 2012 / Journal Publication / Child Welfare Administration and Policy, Sexual Abuse and Assault

Mental Health Professionals in Children's Advocacy Centers: Is There Role Conflict?

Theodore Cross, Janet Fine, Lisa Jones and Wendy Walsh

Children's Advocacy Centers (CACs) are specialized multidisciplinary programs that respond to child abuse in over 700 communities across the U.S. This article is a response to two recent chapters in professional books that have criticized CACs for creating role conflict for mental health professionals, because of their work with criminal justice and child protection professionals in CACs as part of a coordinated response to child abuse. The article argues that these authors overestimate the risk of role conflict. CACs set a boundary between forensic interviewing and therapy. Many mental health professionals in CACs serve as consultants with no clinical responsibility and all are rarely involved in investigation. Participation in multidisciplinary teams focuses on children’s interests and well-being.

Cross, T.P., Fine, J., Jones, L.M. & Walsh, W.A. (2012). Mental health professionals in children’s advocacy centers: Is there role conflict? Journal of Child Sexual Abuse, 21, 91-108.

Feb 2012 / Journal Publication / Child Welfare Practice, Sexual Abuse and Assault

Do Parents Blame or Doubt their Child More When Sexually Abused by Adolescents Versus Adults?

Wendy Walsh, Theodore Cross and Lisa Jones

This study examined factors explaining parental doubt and blame of their child in 161 child sexual abuse cases. Parental blame and doubt was higher when youths were older, when youths were Black and non-Hispanic, and when alleged perpetrators were adolescents (versus adults). Practitioners need to recognize that adolescent victims may be at risk for parental doubt and blame, as may be victims of adolescent perpetrators.

Walsh, W.A., Cross, T.P. & Jones, L.M. (2012). Do parents blame or doubt their child more when sexually abused by adolescents versus adults?. Journal of Interpersonal Violence, 27, 453-470.
Jul 2011 / Presentation / Sexual Abuse and Assault, Well Being

Criminal Investigation in Child Protective Services Cases

Ted Cross, Jesse Helton & Emmeline Chuang

Some advocates argue that police too rarely conduct criminal investigations in Child Protective Services sexual abuse cases, while policy regarding police involvement in CPS physical abuse and neglect cases is not well developed. However, little research has examined how often police investigate in CPS cases and what factors predict involvement. Using two cohorts of cases (1999-2001 and 2008-2009) from the National Survey of Child and Adolescent Well-Being, a national probability study of children involved in CPS investigations, this presentation examines the frequency of criminal investigations in CPS cases and the factors predicting criminal investigation. Across cohorts, criminal investigations took place in 21% to 24% of all cases, 47% to 49% of sexual abuse cases, 24% to 27% of physical abuse cases and 15% to 18% of neglect cases. Police investigated more often when caseworkers reported greater risk and harm to the child and greater evidence, but variables like child age and relationship to perpetrator were not significant. Which county was involved, however, was a major predictor, with enormous variation in rates of police investigation across counties. Thus the likelihood of a criminal investigation depends on severity but also agency differences in practice. Equity suggests the need to discuss these differences.

Oct 2010 / Journal Publication / Sexual Abuse and Assault

Mother Reports of Maternal Support Following Child Sexual Abuse: Preliminary Psychometric Data on the Maternal Self-Report Support Questionnaire (MSSQ)

Daniel Smith, Genelle Sawyer, Lisa Jones, Theodore Cross, Michael McCart, and M. Elizabeth Ralston

Maternal support is an important factor in predicting outcomes following disclosure of child sexual abuse; however, definition of the construct has been unclear and existing measures of maternal support are utilized inconsistently and have limited psychometric data. The purpose of this study was to develop a reliable and valid mother-report measure for assessing maternal support following the disclosure of child sexual abuse.

Smith D. W., Sawyer, G. K., Jones, L. M., Cross, T. P., McCart, M. R., and Ralston M. E. (2010). Mother reports of maternal support following child sexual abuse: Preliminary psychometric data on the Maternal Self-Report Support Questionnaire (MSSQ). Child Abuse & Neglect, 34, 784-792.
Jun 2010 / Presentation / Child Welfare Practice, Sexual Abuse and Assault

Understanding Suspect Confession in Child Sexual Abuse Cases

Theodore P. Cross, Tonya Lippert, Lisa M. Jones & Wendy A. Walsh

Suspect confessions in child sexual abuse investigations help establish the veracity of children's disclosures and empower a speedy, just and healing response. But little is known about the frequency of confessions and what influences suspects to confess. Using data from the Multi-Site Evaluation of Children's Advocacy Centers, this study examines these aspects of confession in a sample of 282 cases in which investigators believed abuse had occurred across four communities. (Presented at the American Professional Society on the Abuse of Children 18th Annual National Colloquium, New Orleans, LA.)

Jun 2010 / Journal Publication / Sexual Abuse and Assault

A Content Analysis of Non-Offending Caregiver and Youth Experiences with Child Sexual Abuse Investigations

Lisa M. Jones, Kathryn E. Atoro, Wendy A. Walsh, Theodore P. Cross, Amy L. Shadoin, Suzanne Magnuson

Qualitative responses by caregivers (n = 203) and youth (aged 8 and older; n = 65) about their experiences with sexual abuse investigations were analyzed in conjunction with quantitative ratings of satisfaction. Respondents described mostly high levels of satisfaction, although dissatisfaction was reported with some key aspects of investigations. The features cited as worse than expected by caregivers were the investigators' commitment to prosecuting the alleged offender and the absence of clear and regular communication about the status of the case. The features mentioned most often by caregivers as better than expected were the emotional support and interviewing skills of investigators. Youth focused both praise and criticism on investigators' interviewing skills. There were relatively few complaints by either caregivers or youth about the duration of the investigation, medical exams, lack of services, or failures of interagency communication, areas of considerable reform in the past several decades. Implications for investigator training and reform initiatives are discussed.

Jones, L. M., Atoro, K. E., Walsh, W. A., Cross, T. P., Shadoin, A. L., & Magnuson, S. (2010). Nonoffending caregiver and youth experiences with child sexual abuse investigations. Journal of Interpersonal Violence, 25, 291-314.
Jun 2010 / Journal Publication / Sexual Abuse and Assault

Suspect Confession of Child Sexual Abuse to Investigators

Tonya Lippert, Theodore Cross, Lisa Jones, & Wendy Walsh

Increasing the number of suspects who give true confessions of sexual abuse serves justice and reduces the burden of the criminal justice process on child victims. With data from four communities, this study examined confession rates and predictors of confession of child sexual abuse over the course of criminal investigations (final N = 282). Overall, 30% of suspects confessed partially or fully to the crime. This rate was consistent across the communities and is very similar to the rates of suspect confession of child sexual abuse found by previous research, although lower than that from a study focused on a community with a vigorous practice of polygraph testing. In a multivariate analysis, confession was more likely when suspects were younger and when more evidence of abuse was available, particularly child disclosure and corroborative evidence. These results suggest the difficulty of obtaining confession but also the value of methods that facilitate child disclosure and seek corroborative evidence, for increasing the odds of confession.

Lippert, T., Cross, T. P., Jones, L., & Walsh, W. (2010). Suspect confession of child sexual abuse to investigators. Child Maltreatment, 15, 161-170.
Jan 2010 / Journal Publication / Sexual Abuse and Assault

Prosecuting Child Sexual Abuse: The Importance of Evidence Type

Wendy A. Walsh, Lisa M. Jones, Theodore P. Cross, Tonya Lippert

Corroborating evidence has been associated with a decrease in children's distress during the court process, yet few studies have empirically examined the impact of evidence type on prosecution rates. This study examined the types of evidence and whether charges were filed in a sample of child sexual abuse cases (n = 329). Cases with a child disclosure, a corroborating witness, an offender confession, or an additional report against the offender were more likely to have charges filed, controlling for case characteristics. When cases were lacking strong evidence (confession, physical evidence, eyewitness), cases with a corroborating witness were nearly twice as likely to be charged. Charged cases tended to have at least two types of evidence, regardless of whether there was a child disclosure or not.

Walsh, W.A., L.M. Jones, Cross, T.P., & Lippert, T. (2010). Prosecuting child sexual abuse: The importance of evidence type. Crime & Delinquency, 56, 436-454.
Jan 2009 / Journal Publication / Sexual Abuse and Assault

Telling Interviewers About Sexual Abuse: Predictors of Disclosure at Forensic Interviews

Tonya Lippert, Theodore Cross, Lisa Jones, & Wendy Walsh

This study aims to identify characteristics that predict full disclosure by victims of sexual abuse during a forensic interview. Data came from agency files for 987 cases of sexual abuse between December 2001 and December 2003 from Children's Advocacy Centers (CACs) and comparison communities within four U.S. states. Cases of children fully disclosing abuse when interviewed were compared to cases of children believed to be victims who gave no or partial disclosures. The likelihood of disclosure increased when victims were girls, a primary caregiver was supportive, and a child's disclosure instigated the investigation. The likelihood of disclosure was higher for children who were older at abuse onset and at forensic interview (each age variable having an independent effect). Communities differed on disclosure rate, with no difference associated with having a CAC. Findings suggest factors deserving consideration prior to a forensic interview, including organizational and community factors affecting disclosure rates.

Lippert, T., Cross,T.P., Jones, L. & Walsh, W. (2009). Telling interviewers about sexual abuse: Predictors of disclosure at forensic interviews. Child Maltreatment, 14, 100-113.
Sep 2008 / Journal Publication / Sexual Abuse and Assault

Families Who Begin and Decline Therapy for Children Who Are Sexually Abused

Tonya Lippert, Tricia Favre, Cindy Alexander, and Ted Cross

The objective of this study was to identify child characteristics, factors related to the therapy referral, and caregivers’ psychological and social variables that predict sexually abused children’s beginning therapy following a therapy referral.

Lippert, T., Favre, T., Alexander, C. & Cross, T.P. (2008). Families who begin and decline therapy for children who are sexually abused. Child Abuse & Neglect, 32, 859-868
Aug 2008 / Report / Sexual Abuse and Assault

The Multi-Site Evaluation of Children's Advocacy Centers: Overview of the Results and Implications for Practice

Theodore P. Cross, Lisa M. Jones, Wendy A. Walsh, MoniqueSimone, David J. Kolko, Joyce Szczepanski, Tonya Lippert, Karen Davison, Arthur Cryns, Polly Sosnowski, Amy Shadoin, and Suzanne Magnuson

This bulletin reports results from a multi-site quasi-experimental evaluation of the impact of Children's Advocacy Centers (CACs). CACs are multidisciplinary organizations designed to provide a coordinated, child-friendly investigation and service response in cases of alleged child sexual abuse or other serious abuse. Compared to non-CAC comparison communities, non-offending caregivers in CACs reported greater satisfaction with the investigation, and children were more likely to receive forensic medical examinations and referrals for mental health services. The bulletin provides a comprehensive overview of study results and discusses the implications for practice in the response to serious child abuse.

Aug 2008 / Report / Child Welfare Practice, Sexual Abuse and Assault

Evaluating Children's Advocacy Centers' Response to Child Sexual Abuse

Theodore P. Cross, Lisa M. Jones, Wendy A. Walsh, Monique Simone, David J. Kolko, Joyce Szczepanski, Tonya Lippert, Karen Davison, Arthur Cryns, Polly Sosnowski, Amy Shadoin, and Suzanne Magnuson

This Bulletin describes the findings of an evaluation of the effectiveness of the CAC model in four prominent Children's Advocacy Centers and nearby comparison communities. Findings demonstrate the important role these centers can play in advancing child abuse investigations and suggest ways in which the model could be improved in the future.

Jan 2008 / Journal Publication / Sexual Abuse and Assault

How Long Does it Take to Prosecute Child Sexual Abuse? An Analysis of Time to Disposition

Wendy A. Walsh, Tonya Lippert, Theodore P. Cross, Danielle M. Maurice and Karen S. Davison

This article explores the length of time between key events in the criminal prosecution of child sexual abuse cases (charging decision, case resolution process, and total case-processing time), which previous research suggests is related to victims' recovery. The sample included 160 cases in three communities served by the Dallas County District Attorney. Most cases (69%) took at least 60 days for the charging decision, with cases investigated at the Children's Advocacy Center having a quicker time than either comparison community. Only 20% of cases had a case resolution time within the 180-day target suggested by the American Bar Association standard for felonies. Controlling for case characteristics, one of the three communities and cases with an initial arrest had a significantly quicker case resolution time. Total case processing generally took more than 2 years. Implications include the need to better monitor and shorten case resolution time.

Walsh, W.A., Lippert, T., Cross, T.P., Leblanc, D. & Davison, K. (2008). How long does it take to prosecute child sexual abuse? An analysis of time to disposition. Child Maltreatment, 13, 3-13.
Jan 2007 / Journal Publication / Sexual Abuse and Assault

Do Children's Advocacy Centers Improve Families' Experiences of Child Sexual Abuse Investigations?

Lisa M. Jones, Theodore P. Cross, Wendy A. Walsh & Monique Simone

The Children's Advocacy Center (CAC) model of child abuse investigation is designed to be more child and family-friendly than traditional methods, but there have been no rigorous studies of their effect on children's and caregivers' experience. Data collected as part of the Multi-Site Evaluation of Children's Advocacy Centers were used to examine whether CACs improve caregivers' and children's satisfaction with investigations. Nonoffending caregiver and child satisfaction were assessed during research interviews, including the administration of a 14-item Investigation Satisfaction Scale (ISS) for caregivers. Two hundred and twenty-nine sexual abuse cases investigated through a CAC were compared to 55 cases investigated in communities with no CAC. Hierarchical linear regression results indicated that caregivers in CAC cases were more satisfied with the investigation than those from comparison sites, even after controlling for a number of relevant variables. There were few differences between CAC and comparison samples on children's satisfaction. Children described moderate to high satisfaction with the investigation, while a minority expressed concerns about their experience. The CAC model shows promise for improving families' experiences, but to build upon this promise, agencies will need to systematize procedures for refining and adapting the model as new research becomes available.

Jones, L.M., Cross, T.P., Walsh, W. & Simone, M. (2007). Do Children's Advocacy Centers improve families' experiences of child sexual abuse investigations? Child Abuse & Neglect, 31, 1069-1085.
Jan 2007 / Journal Publication / Sexual Abuse and Assault

Child Forensic Interviewing in Children's Advocacy Centers: Empirical Data on a Practice Model

Theodore P. Cross , Lisa M. Jones, Wendy A. Walsh, Monique Simone, David Kolko

Children's Advocacy Centers (CACs) aim to improve child forensic interviewing following allegations of child abuse by coordinating multiple investigations, providing child-friendly interviewing locations, and limiting redundant interviewing. This analysis presents one of the first rigorous evaluations of CACs' implementation of these methods. This analysis is part of a quasi-experimental study, the Multi-Site Evaluation of Children's Advocacy Centers, which evaluated four CACs relative to within-state non-CAC comparison communities. Case abstractors collected data on investigation methods in 1,069 child sexual abuse cases with forensic interviews by reviewing case records from multiple agencies. CAC cases were more likely than comparison cases to feature police involvement in CPS cases (41% vs. 15%), multidisciplinary team (MDT) interviews (28% vs. 6%), case reviews (56% vs. 7%), joint police/child protective services (CPS) investigations (81% vs. 52%) and video/audiotaping of interviews (52% vs. 17%, all these comparisons p < .001). CACs varied in which coordination methods they used, and some comparison communities also used certain coordination methods more than the CAC with which they were paired. Eighty-five percent of CAC interviews took place in child-friendly CAC facilities, while notable proportions of comparison interviews took place at CPS offices (22%), police facilities (18%), home (16%), or school (19%). Ninety-five percent of children had no more than two forensic interviews, and CAC and comparison differences on number of interviews were mostly non-significant. Relative to the comparison communities, these CACs appear to have increased coordination on investigations and child forensic interviewing. The CAC setting was the location for the vast majority of CAC child interviews, while comparison communities often used settings that many consider undesirable. CACs showed no advantage on reducing the number of forensic interviews, which was consistently small across the sample.

Cross, T.P., Jones, L., Walsh, W., Simone, M. & Kolko, D. (2007). Child forensic interviewing in children's advocacy centers: Empirical data on a practice model. Child Abuse & Neglect, 31, 1031-1052.
Jan 2007 / Journal Publication / Sexual Abuse and Assault

Which Sexual Abuse Victims Receive a Forensic Medical Examination? The Impact of Children's Advocacy Centers

Wendy Walsh, Theodore Cross, Lisa Jones, Monique Simone, & David Kolko

This study examines the impact of Children's Advocacy Centers (CAC) and other factors, such as the child's age, alleged penetration, and injury on the use of forensic medical examinations as part of the response to reported child sexual abuse. This analysis is part of a quasi-experimental study, the Multi-Site Evaluation of Children's Advocacy Centers, which evaluated four CACs relative to within-state non-CAC comparison communities. Case abstractors collected data on forensic medical exams in 1,220 child sexual abuse cases through review of case records. Suspected sexual abuse victims at CACs were two times more likely to have forensic medical examinations than those seen at comparison communities, controlling for other variables. Girls, children with reported penetration, victims who were physically injured while being abused, White victims, and younger children were more likely to have exams, controlling for other variables. Non-penetration cases at CACs were four times more likely to receive exams as compared to those in comparison communities. About half of exams were conducted the same day as the reported abuse in both CAC and comparison communities. The majority of caregivers were very satisfied with the medical professional. Receipt of a medical exam was not associated with offenders being charged. Results of this study suggest that CACs are an effective tool for furthering access to forensic medical examinations for child sexual abuse victims.

Walsh, W., Cross, T.P. , Jones, L., Simone, M. & Kolko, D. (2007). Which sexual abuse victims receive a forensic medical examination? The impact of children's advocacy centers. Child Abuse & Neglect, 31, 1053-1068.
Jan 2001 / Journal Publication / Sexual Abuse and Assault

Polygraph Testing and Sexual Abuse: The Lure of the Magic Lasso

Theodore P. Cross & Leonard Saxe

Polygraph tests to assess veracity are widely promoted for application in sexual abuse matters. The use of polygraph tests is advocated despite substantial differences in professional and scientific opinion about the validity of such techniques. Polygraph diagnoses of an individual's deception are inferences made by an examiner who compares physiological reactions to a set of questions. The test situation, however, is also used to induce examinees to admit crimes. In addition to their use in investigations, polygraph tests are used by defendants seeking exculpatory evidence and by treatment and probation programs to assess and monitor sexual offenders. Although there are dissenters, most knowledgeable scientists consider polygraph testing as unvalidated. Professionals need to access the literature on polygraph testing, evaluate the efficacy and ethics of polygraph tests in their community, and further develop standards for their use.

Cross, T.P. & L. Saxe (2001). Polygraph testing and sexual abuse: The lure of the magic lasso. Child Maltreatment, 6, 195-206.



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