Indicators of activity

Artefact 1
Rebecca L. Moles, M.D.

John M. Leventhal, M.D.DOI:https://doi.org/10.1016/j.jadohealth.2014.06.009

In this issue, Finkelhor. Extend their previous epidemiologic studies of sexual

abuse and assault of children using data from three national phone surveys and
focusing on information obtained from 15- to 17-year-old adolescents [

1
]. The authors aimed to provide an estimate of the lifetime prevalence of childhood
sexual abuse and assault and to include adolescents through the age of 17 years.
Similar studies have examined childhood sexual abuse and assault by questioning
adults about their childhood experiences which may have occurred years before.
This study questioned 15-, 16-, and 17-year olds about their experiences of sexual
abuse and assault to decrease recall bias and to capture a snapshot of the
experiences of older teens. The questions about sexual victimization common to
the three surveys included reports of a “grown-up” familiar to the teen forcing
sexual touching or sex, a “grown-up” stranger forcing sexual touching or sex, a
known other child or teen forcing sexual acts or sex (including siblings), and
attempts of sexual acts by anyone even if none occurred.
In this editorial, we highlight four key points of the article, remind clinicians who
care for children and adolescents of the importance of these study findings and
implications for practice, and issue a call to action for the prevention of childhood
sexual abuse and assault.
The first key point of Finkelhor et al. is that clear definitions are important.
Incidence and prevalence studies often combine sexual abuse and assault [
1
]. The article refers to this phenomenon as a “terminological ambiguity.” Sexual
abuse often refers to sexual acts by adult caregivers in the family; by adults in the
caregiving role, such as a coach; or by older children in the family, such as an
older sibling or cousin. In contrast, the term sexual assault is often reserved for
sexual acts by strangers or by the same-age peers. The risk factors, prevention
efforts, and treatment strategies may differ between these two phenomena, but the
statistics for each are often combined, making understanding the true occurrence of
each difficult or impossible. The authors provided clear definitions and reported
the overall results and the results by types of perpetrators (adult or juvenile, male
or female, and family, acquaintance, or stranger). Overall, the authors found that
one in four girls and one in twenty boys experienced sexual abuse or assault in
their lifetimes. When just sexual abuse by an adult was examined, the lifetime
prevalence was one in nine girls and 1 in 53 boys. Juvenile offenders committed
well over half of the total abuse and assault episodes of female or male children.
When citing data or using rates of abuse and/or assault to shape guidelines for
clinical care, public policy, or funding, it is important to understand the difference
between assault and abuse and specifically what the data represent.
The second key point relates to the relationship between the child and the
perpetrator of the sexual abuse or assault. Strangers were the least commonly
reported perpetrator; most commonly, the acts were by an acquaintance of the
child. These data challenge the public's perception of child sexual abuse or assault
as being perpetrated by strangers. Educational programs need to focus on helping
children and teens to protect themselves from people they know [
2
].
A third and related key point is that most of the sexual abuse or assault reported
through the age of 17 did not include penetration. Many state statutes include more
stringent penalties for penetration versus genital touching, which may contribute to
the perception that penetration is somehow more “wrong” than other sexual contact
or touching. One longitudinal study of outcomes of sexual abuse found an
increased rate of psychopathology in survivors of any type of sexual abuse or
assault, with a tendency toward even higher rates in those who had experienced
penetration as part of the abuse [
3
]. It is important to recognize that all forms of child abuse and neglect have been
linked to poor medical and psychiatric health outcomes; the biologic and
epigenetic bases of the outcomes are being uncovered and are beginning to be
applied to public policy development [
4
]. Penetration should not be viewed as the sole marker of severity of abuse or
predictor of long-term outcomes for the survivors.
Finally, separating the survey responses by teens of different ages highlighted the
important differences in the experiences of older adolescents. The rates of abuse by
all types of perpetrators rose steadily among the 15-, 16-, and 17-year olds. In 15-
year-old females, 16.8% reported sexual abuse or assault in their lifetime; the
number of 17-year-old girls reporting sexual abuse or assault was much higher at
26.6%. These data indicate that a significant amount of the sexual abuse and
assault experienced by girls occurs between the ages of 15 and 17 years. The mid-
to late-teen years are a time when many adolescents are gaining independence:
sleepovers at friends' homes, taking a first job, initiating dating, and starting to
drive a car. These data indicate that these ages may also be the time that such
young people are especially vulnerable to unwanted sexual acts by peers and
adults. Prevention programs for adolescents should focus on strategies both to help
teenagers avoid vulnerable or dangerous situations and how to exit such situations.
These data have important implications for clinicians who care for children and
adolescents. Pediatric clinicians often use the HEEEADSSS acronym to assess
important aspects of the lives of teens that impact overall health and safety,
including Home, Education/Employment, Eating, Activities, Drugs, Sexuality,
Suicide or Depression, and Safety from Injury and Violence [
5
]. The results of Finkelhor support and underscore the importance of the sexuality,
suicide, and safety section and its use at health maintenance visits, especially
during later adolescence. Clinicians need to be both willing to ask and comfortable
hearing from teens about sexual abuse and assault. Clinicians also must know
when to report to child protective services and how to access trauma-focused
therapy for those teens who do report sexual abuse or assault.
Although the identification of these young people who have experienced sexual
abuse or assault is important, as in all of pediatrics, prevention is the best medicine.
The fact that 25% of females self-identify as lifetime victims of childhood sexual
abuse and/or assault is chilling. An inherited trait present in 25% of a population
would be considered a normal variant. Will physicians, parents, lawmakers, and
society allow sexual abuse and assault to be “normal”? The results of this study are
a plea to take notice of what is happening to children and teens and to prioritize
prevention through school education, teen programs, and parenting awareness
campaigns. There are educational programs aimed at preventing teens from
offending on each other by teaching respect and boundaries and appropriate sexual
behaviors [
6
, 
7
, 
8
], but there must be a renewed focus on implementing such programs and on
developing other strategies to prevent the sexual abuse and assault of young
people.
Artefact 2
Unmasked

© Bruk Linn

Published: October 2018

Don't believe my words;

they're lies that I fabricate to
project a perfect life and
convince you I'm okay.   
    
Don't trust the smile you see; 
it's a facade to conceal
searing pain, acute shame,
sheer heartache.

Don't get fooled by my laughter;

it is merely an echo
of hollow insides, yearning
for senses to return.

Don't get convinced by my clarity and order;

borne in attempt to
control the chaos   
and pacify the storm brewing inside.

Don't be blinded by
The perfection I exude,
The courage I fake,
The innocence I feign, 
The confidence I wear-
For I am broken.

Source: https://www.familyfriendpoems.com/poem/unmasked-2
Artefact 3
Million Reasons

Lady Gaga
You're giving me a million reasons to let you go
You're giving me a million reasons to quit the show
You're givin' me a million reasons
Give me a million reasons
Givin' me a million reasons
About a million reasons
If I had a highway, I would run for the hills
If you could find a dry way, I'd forever be still
But you're giving me a million reasons
Give me a million reasons
Givin' me a million reasons
About a million reasons
I bow down to pray
I try to make the worst seem better
Lord, show me the way
To cut through all his worn out leather
I've got a hundred million reasons to walk away
But baby, I just need one good one to stay
Head stuck in a cycle, I look off and I stare
It's like that I've stopped breathing, but completely aware
'Cause you're giving me a million reasons
Give me a million reasons
Givin' me a million reasons
About a million reasons
And if you say something that you might even mean
It's hard to even fathom which parts I should believe
'Cause you're giving me a million reasons
Give me a million reasons
Givin' me a million reasons
About a million reasons
I bow down to pray
I try to make the worst seem better
Lord, show me the way
To cut through all his worn out leather
I've got a hundred million reasons to walk away
But baby, I just need one good one to stay
Oh baby, I'm bleedin', bleedin'
Stay
Can't you give me what I'm needin', needin'
Every heartbreak makes it hard to keep the faith
But baby, I just need one good one
Good one, good one, good one, good one, good one
When I bow down to pray
I try to make the worst seem better
Lord, show me the way
To cut through all his worn out leather
I've got a hundred million reasons to walk away
But baby, I just need one good one, good one
Tell me that you'll be the good one, good one
Baby, I just needone good one to stay
Source: LyricFind
Songwriters: Hillary Lee Lindsey / Mark Ronson / Stefani Germanotta
Million Reasons lyrics © Sony/ATV Music Publishing LLC, BMG Rights
Management, Concord Music Publishing LLC